SEMINAR ON PREVENTIVE OBSTETRICS
SUBMITTED TO
SUBMITTED BY
Mrs. INDU BALAKRISHNAN BALAKRISHNA N
DRISYA.V DRISYA.V..R. 1st year MSc Nrs!"#
Asst.Professor $o%t.Co&&e#e of Nrs!"#
$o%t.Co&&e#e of Nrs!"#
A&a''()a
A&a''()a 0
INDE*
Sl. no:
CONTENT
Page no:
1.
INTRODUCTION
3
2.
PREVENTIVE OBSTETRICS: Definition
4
3.
Pe!enti!e O"#teti$# %ea#&e# '. 'ntenatal N&#ing
4,2-
B. Intanatal N&#ing
2-,3
C. Po#tnatal N&#ing
31,42
4.
RE('TED RE('TED RESE'RC)ES R ESE'RC)ES
43,4/
5.
CONC(USION
4/,4-
6.
BIB(IO*R'P)+
4-
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Cental o"0e$ti!e: On $oletion of te $la## te #t&ent# a$&ie 7no8lege egaing e!enti!e o"#teti$# ae$iate# ae$iate# it# iotan$e an &#e of ti# 7no8lege in te aea# of ofe##ion
Se$ifi$ o"0e$ti!e: 't te en of te $la## te #t&ent# ae a"le to: • • •
Define e!enti!e o"#teti$# %ention e!enti!e o"#teti$# ea#&e# E9lain e!enti!e o"#teti$# ea#&e# antenatal n&#ing Intanataln&#ing o#tnatal n&#ing
2
INTRODUCTION Pe!enti!e o"#teti$# i# te $on$et of e!ention o eal ete$tion ofati$&la ealt e!iation# to&g o&tine eioi$ e9aination# an #$eening#. Te $on$et of e!enti!e o"#teti$# $on$en# 8it te $on$et# of te ealt an 8ell, "eing of te ote an e "a" &ing te antenatal intanatal an o#tnatal eio. It ai# to oote te 8ell, "eing of ote# an "a"ie# an to #&ot #o&n aenting an #ta"le failie#. N&#ing $ae $entee on ealt ootion an ealt aintenan$e &ing egnan$ e#ent# an e9$ellent oot&nit fo n&#e# to tea$ e9e$tant ote# a"o&t noal $ange# e9e$te an alet te to a !aiet of i#7 fa$to#.
3
PREVENTIVE OBSTETRICS Pre%e"t!%e
Pe!enti!e i# te te &#e to e!ention o #lo8ing te $o&#e of an illne## o i#ea#e. It i# intene o &#e to e!ent o ine a$ting a# an o"#ta$le. O+stetr!c
Te "an$ of ei$ine tat eal# 8it te $ae of 8oen &ing egnan$ $il"it an e$&eati!e eio follo8ing eli!e i# 7no8n a# o"#teti$. Pe!e Pe!ent nti! i!ee o"#t o"#tet eti$ i$ i# te te te te fo fo e! e!en enti tion on of te te $o $oli li$a $ati tion on tat tat a a ai#e&ing antenatal intanatal an o#tnatal eio. $OAL AND AIM
Te goal of of te e!enti!e o"#teti$# i# te eli!e of a ealt infant " aealt ot ote at te en of a ealt eg egnan$. Peg egnan$ an $il "it t noal#iologi$ o$e## tat $ange fo $on$etion to eli!e. Te n&#e a# a &ni&eoot&nit to einfo$e te noal $$le of te#e o$e##e# an at te #ae tie a##e##$lient fo o"le# tat e&ie inte!ention. 'itionall te n&#e $an tea$ $lient#a"o& $lient#a"o&tt te $ange# tat ae ta7ing la$e an o!ie o!ie !al&a"le !al&a"le g&ian$e fo $lient# a"o&t8en to #ee7 g&ian$e fo ealt $ae o!ie#. o!ie#. Te aim of e!enti!e o"#teti$# i# to en#&e tat to&g te egnan$ an &eei& te ote 8ill a!e goo ealt an tat e!e egnan$ a $&linatein a ealt ote an a ealt "a". Pe!enti!e O"#teti$ ea#&e $an "e $ategoi;e into tee ain #tage#. Teae a# follo8#:, '. 'ntenatal N&#ing B. Intanatal N&#ing C. Po#tnatal N&#ing A.ANTENAT A.ANTENATAL NURSING
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'ntenatal $ae i# te $ae &ing egnan$. 'ntenatal $ae i# e##ential e!en fo anoal an ealt egnant 8oen fo e o8n 8ell, "eing an tat of te "a" to "e"on "e$a&#e no egnan$ an $il "it i# fee fo i#7 fo "ot ote an "a". Ieall te $ae #o&l #tat ieiatel afte $on$etion "&t a$ti$all a# eal a#o##i"le &ing te fi#t tie#te an #o&l $ontin&e to&go&t te #e$on an titie#te#. OB
To oote ote$t an aintain te ealt of te ote &ing egnan$. To ete$t >ig i#7? $a#e# an gi!e te #e$ial attention. To foe#ee $oli$ation# an e!ent te. To eo!e an9iet an ea a##o$iate 8it eli!e. To e&$e atenal an infant otalit an o"iit. To tea$ te ote eleent# of $il $ae n&tition e#onal giene anen!ionental #anitation. To #en#iti;e te ote to te nee fo fail lanning in$l&ing a!i$e to$a#e# #ee7ing ei$al teination of egnan$. To ete$t an teat an a"noalit fo&n in egnan$ a# eal a# o##i"le.
1. Preco"ce't!o"a& Co"se&!"# a", Care
@en $o&le i# #een an $o&n#ele a"o&t egnan$. It# $o&#e an o&t$oe 8ell"efoe te tie of a$t&al $on$etion i# $alle e$on$etion $o&n#eling. It i# a !e ne8$on$et. O"0e$ti!e i# to en#&e tat a 8oan ente# egnan$ 8it an otial #tate ofealt 8i$ 8o&l "e #afe "ot to e#elf an te fet&#. Oganogene#i# i# $olete "te 1#t tie#te. B te tie te 8oan i# #een fi#t in te antenatal $lini$ it i# often toolate to a!i$e "e$a&#e all te a!e#e fa$to# a!e alea "eg&n to e9et tei effe$t. In an ieal 8ol antenatal $ae 8ol $oen$e at te e$on$etion #tage 8eeealt e&$ation Ageneal a!i$e a"o&t n&tition life#tle a!oian$e of teatogen# foli$a$i #&leentation et$. an i#7 a##e##ent $an "e fo$&#e to8a a lanneegnan$. Pe$on$etion $o&n#eling i# of &$ geate iotan$e in t8o ain go&# of 8oen: One# 8it &neling ei$al $onition# tat a "e affe$te " o a infl&en$ete o&t$oe of egnan$. E9ale# of #&$ $onition# in$l&e ia"ete# !aio&#eno$inoatie# eo#tati$ o to"oti$ o"le an 5
$aia$ i#ea#e. Patient#follo8ing ogan tan#lantation A7ine li!e eat an l&ng# ae al#o no8$onti"&ting to te an7# of te#e atient# along 8it #&!i!o# of $ilooalignan$ie#. ' <ii#$ilina aoa$ to otii;e #ta"ili;e te &neling$onition an lanning $ae &ing te antenatal eio i# a 7e $oonent tootii;ing egnan$ o&t$oe. One# 8ee tee ae ientifia"le fa$to# tat 8o&l #&gge#t te $o&le ae at a i#7of fetal anoal. S&$ ientifia"le fa$to# a in$l&e a e!io&# $il affe$te "a #ingle gene i#oe o #noi$ i#oe a fail i#to of geneti$ i#oe oi#to of aental $oo#oal a"noalit.
Co&n#eling i# a a0o at of enatal iagno#i#. Te a0oit of aent# to "e o note$ei!e te#el!e# at i#7 an 5 e$ent of a"noalitie# o o$$& &ne9e$tel inegnan$ie# not $on#iee at i#7. Preco"ce't!o"a& Co"se&!"# eit# Ientifi$ation of ig i#7 fa$to# i# one " etaile e!al&ation of
ei$alo"#teti$ fail an e#onal i#to. Ri#7 fa$to# ae a##e##e " la"oatote#t# if e&ie. Teata"le fa$to# li7e e, e9i#ting $oni$ i#ea#e# Aeten#ion ia"ete#eile# ae #ta"ili;e in an otial #tate " eal inte!ention "efoeegnan$. Poe $o&n#eling to to#e 8it i#to of e$&ent fetal lo## o 8it faili#to of $ongenital a"noalitie# Ageneti$ $oo#oal o #t&$t&al a# teea "e #oe &nteata"le fa$to#. O!e8eigt o &ne8eigt i# to "e $oe$te 8it oe ieta a!i$e. R&"ella an eatiti# i∋ation in a non i&ne 8oan i# to "e offee. To e$o a "a#e le!el ealt #tat&# in$l&ing BP eaing. =oli$ a$i #&leentation A4g a a #tating 4 8ee7# io to $on$etion & to12 8ee7# of egnan$ i# a!i#e. *oo &ne#taning 8it te #i$ian #o tat &$ of te o"le# an fea ofte in$oing egnan$ $o&l "e eo!e. Te $o&n#eling #o&l "e one "ia ealt $ae o!ie#. Te el of o"#teti$ian# #i$ian# an geneti$i#t#a "e e&ie an #o&l "e e9tene. -. Esse"t!a& A"te"ata& Care Ser%!ces
Te e##ential $oonent# of #e!i$e# &ing egnan$ in$l&e ae:, 6
Regi#tation of Pegnant @oen 'ntenatal Vi#it# an 'ntenatal Cae I∋ation 'gain#t Tetan&# Ion an =oli$ '$i an Vitain ' an D S&leentation )ealt e&$ation enatal a!i$e &ing Pegnan$
Registration of Pregnant Women
Cae &ing egnan$ #o&l "e #tate a# eal a# o##i"le. Te ote &#t "e egi#tee 8itin 2 8ee7# of egnan$ eite at ealt $ente antenatal $lini$ o atoe " a n&#eealt !i#ito feale ealt 8o7e A'N% o taine e#on. To&g#i$al an o"#teti$al $e$7& #o&l "e one to #$een fo i#7 fa$to# a7ea##e##ent an gi!e aoiate $ae fo e!ention an $ontol of !aio&# ealto"le# an $oli$ation#. Antenatal Visits and Antenatal Care Ieall a 8oan #o&l "e #een an gi!en $ae &ing egnan$ on$e a ont &ingte fi#t tie#te o till #e!en ont# on$e in fotnigt &ing te #e$on tie#te otill te eigt ont an teeafte e!e 8ee7 till $onfineent. B&t often te#e an!i#it# ae not fea#i"le neite fo te ote no fo te ealt infa#t&$t&e a!aila"le. Te $ae #o&l "egin #oon afte $on$etion an $ontin&e to&go&t egnan$. '#$e&le to follo8 fo te ote i# to atten te antenatal $lini$ on$e a ont &ingte fi#t #e!en ont# t8i$e a ont &ing te ne9t t8o ont# an teeafte on$e a8ee7 if e!eting i# noal. Teefoe a ini& tee !i#it# one in ea$ tie#tea!e "een e$oene. Te fi#t !i#it #o&l "e one 8itin 2 8ee7# o a# eal a# te ote i#egi#tee. Te #e$on !i#it at 32 8ee7# of egnan$. Te ti !i#it at 36 8ee7# of egnan$. =&te !i#it# a "e ae if 0&#tifie " te $onition of te ote. 't lea#t one !i#it#o&l "e ai in te oe of te ote to a7e o"#e!ation of a$t&al $onition# ana$$oingl eae te ote. Te ain &o#e of $onta$t &ing antenatal eio i#to a7e o"#e!ation# an a##e## geneal ealt o"#teti$al ealt #tat&# ientif i#7fa$to# an o!ie aoiate $ae. T)e 're%e"t!%e ser%!ces for ot)ers!" t)e 're"ata& 'er!o, ae a#follo8#:, Te fi#t !i#it ie#e$ti!e of 8en it o$$&# #o&l in$l&e:, a Ta7ing )ealt )i#to 7
It in$l&e# e$oing i#to of en#t&ation ei$al i#to o"#teti$al i#to#o$ioe$onoi$ i#to. " P#i$al E9aination It in$l&e# e$oing of eigt 8eigt "loo e##&e teeat&e &l#e et$. genealo"#e!ation# fo ea to toe. $ O"#teti$al E9aination It in$l&e# geneal o"#e!ation# e9aination of "ea#t# a"oinal ea#&eentalation an in#e$tion !aginal e9aination if ne$e##a. (a"oato In!e#tigation# F Colete &ine anal#i# F Stool e9aination F Colete "loo $o&nt in$l&ing eoglo"in e#tiation. F Seologi$al e9aination. F Bloo go&ing an R eteination. F Ce#t G, a if neee F *onoea te#t if neee On #&"#e&ent !i#it# F P#i$al e9aination in$l&ing 8eigt an "loo e##&e F (a"oato te#t# in$l&ing &ine e9aination an eoglo"in e#tiation F Ion an foli$ a$i #&leentation an ei$ation# a# neee. F I∋ation again#t tetan&# F *o& o ini!i&al tea$ing on n&tition #elf,$ae fail lanning eli!ean aentoo F )oe !i#iting " a feale ealt 8o7e o taine e#on Ataine taitional "it attenant F Refeal #e!i$e# 8en ne$e##a Risk Approach @ile $ontin&ing to o!ie aoiate $ae fo all ote# Hig i#7 $a#e# &#t "eientifie a# eal a# o##i"le an aangeent# to "e ae fo #7ille $ae. Te#e $a#e#$oi#e te follo8ing:, @oen "elo8 1- ea# of age o o!e 35 ea# in iiga!ia. • @oen 8o a!e a fo& o oe egnan$ie# an eli!eie#. • Sot #t&$t&e iiga!ia • To#e 8o a!e a$ti$e le## tan 2 ea# o oe tan 1 ea# of "it • #a$ing. To#e 8it $ealoel!i$ i#ootion ACPD genital ola#e. • %ale#entation# e.g. "ee$ tan#!e#e lie et$. • 8
'nteat& eoage teatene a"otion Pee$la#ia an e$la#ia • 'neia • T8in# anio# • Pe!io&# #till"it inta&teine eat an&al eo!al of la$enta • Elel gan <iaa • To#e ote 8it "loo R negati!e. • To#e 8it o"e#it an aln&tition. • Polonge egnan$ A 14 a# "eon e9e$te ate of eli!e • Pe!io&# $e#aean o in#t&ental eli!e • Pegnan$ a##o$iate 8it ei$al $onition# e.g. $aio!a#$&la i#ea#e • 7inei#ea#e ia"ete# t&"e$&lo#i# li!e i#ea#e et$. Te &o#e of i#7 aoa$ i# to o!ie a9i& #e!i$e# to all egnant 8oen 8it attention to to#e 8o nee te o#t. %a9i& &tili;ation of all e#o&$e#in$l&ing &an e#o&$e# i# in!ol!e in #&$ $ae. Se!i$e# of taitional "itattenant# $o&nit ealt 8o7e# an 8oen# go&# ae &tili;e. Te i#7#tateg i# e9e$te to lea to io!eent# in "ot te &alit an $o!eage of ealt$ae at all le!el# ati$&lal at ia ealt $ae le!el. Pre%e"t!o" F 'ini#tation of foli$ a$i 5g ail ont# "efoe $on$etion. F B io!ing e, egnan$ ealt of 8oan. F Po!iing &alit antenatal $ae. F S$eening all egnan$ie# fo ig i#7. F Po!ie aoiate $lini$al an te$nologi$al $ae " #e$iali#t on tie. F Pe!ent all 7in# of infe$tion. F Eal iagno#i# of alfoation an teination. F '!oian$e of ei$ation A8ito&t #i$ian# e#$ition. F )ealt e&$ation on %C) an =P $ae. Maintenance of Records Te antenatal $a i# eae at te fi#t e9aination. It i# geneall ae of ti$7 ae to fa$ilitate filing. It $ontain# a egi#tation n&"e ientifing ata e!io&#ealt i#to an ain ealt e!ent#. Te e$o i# 7et at te %C)=P $ente. ' lin7i# aintaine "et8een te 'ntenatal $a Po#tnatal $a an &ne, fi!e# $a.%aintenan$e of e$o# i# e##ential fo e!al&ation an f&te io!eent of %C)=P#e!i$e#. Home Visit •
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)oe !i#it# ae ai " te =eale )ealt @o7e o P&"li$ )ealt N&#e. If te eli!e i# lanne at oe #e!eal !i#it# ae e&ie. Te oe !i#it 8ill o!ie oot&nitie# to #t& te en!ionental an #o$ial $onition# at oe an to o!ieenatal a!i$e. In te oe en!ionent te 8oan 8ill a!e oe $onfien$e toa7e an infoe e$i#ion a"o&t oe "it. Immunization Against Tetanus
' egnant 8oan &#t get t8o in0e$tion# of Tetan&# To9oi &ing te eio "et8een 16 36 8ee7# at one ont inte!al. Te#e ote$t te ote an "a" "otfo te i#7 of tetan&#. Te 2n in0e$tion #o&l efea"l "e gi!en at lea#t at oneont "efoe eli!e. If a 8oan i# egi#tee late ten in tat $a#e e!en one in0e$tion8ill o. If te 8oan i# i∋e ealie 8itin tee ea# of te egnan$ tenone "oo#te o#e 8ill "e eno&g. Iron and oli! A!id and Vitamin A and " Su##lementation It i# "eing fo&n tat 5,6 e$ent of egnant 8oen ae anaei$ &e to ion efi$ien$ie#. 'naeia i# al#o agga!ate in egnan$. It i# teefoe iotant to ta7e one ta"let $ontaining 6 g of eleental ion an 5 g of foli$ a$i tee tie# ailafte ti ont of egnan$ till 3 ont# afte $il "it if te ote i# fo&na!ing anaeia. D&ing egnan$ te ote e&ie# e9ta ion an foli$ a$i &e to $ange# ta7ingla$e in te "o an go8t of fet&# in te 8o". Teefoe ea$ ote i# gi!en oneta"let of ion an foli$ a$i t8i$e a a fo at lea#t 1 a# to e!ent anaeia inote an to oote oe go8t of fet&#. 'neia i# $oon in egnan$ an lo8 in$oe go&. It i# a a0o $a&#e ofatenal an fetal otalit. Pre%e"t!o" of A"e!a A$oidan!e of fre%uent of !&ild 'irt&: 't lea#t t8o ea# an inte!al "et8een egnan$ie# i# o#t ne$e##a to ela$e te lo#t ion &ing $il"it o$e## anla$tation. Ti# $an "e a$ie!e " oe fail lanning g&ian$e. Su##lementar( iron T&era#(: Ion #&leenta #o&l "e a o&tine afte teatient "e$oe# fee fo na&#ea an !oiting. Dail 6g ion 8it 1g foli$a$i i# a &ite effe$ti!e ola$ti$ o$e&e. "ietar( Pres!ri#tion: @ell,"alan$e iet i$ in ion an otein #o&l "ea!i#e. Te foo i$ in ion ae li!e eat egg geen !egeta"le# geen ea "ean 8ole 8eat et$.
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Ade%uate treatment # o&l "e in#tit&te to eai$ate te illne## li7el to
$a&#eaneia. Te#e ae oo78o infe#tation #ente an alaia "leeing ile#&ina ta$t infe$tion et$. Earl( dete!tion of falling &emoglo'in le$el i# to "e ae. )eoglo"in le!el #o&l"e e#tiate at te fi#t antenatal !i#it at te 2-t an finall at 36t 8ee7#. A$oid e)!essi$e 'lood loss &ing te 2n #tage of la"o&. *ealt& edu!ation + #renatal ad$i!e during Pregnan!( ' a0o $oonent of antenatal $ae i# ealt e&$ation an enatal a!i$e. Teote i# oe e$eti!e to a!i$e $on$ening e#elf an e "a" at ti# tie tan anote tie. ' 8oan &ing egnan$ nee# to 7no8 a"o&t e n&tition e#onalgiene e#t an #lee e9e$i#e &#e of &g# 8aning #ign# et$. Pegnan$ $an "e "ot an e9$iting an 8oing tie fo te ote an e atne. Pat of te ole of te ealt $ae ofe##ional# A&#&all f&lfille " te $o&niti8ife an geneal a$titione $aing fo te ote i# te o!i#ion of infoationa"o&t e!ea a$ti!itie# tat a o a not "e affe$te " o a!e an effe$t on teegnan$. Diet &ing egnan$ Pe#onal )giene Re#t an Slee P#i$al 8o7 E9e$i#e Cofota"le $loting an #oe# So7ing 'l$ool Bea#t Cae D&g# Raiation Pote$tion# fo infe$tion# an illne##e# Se9&al a$ti!itie# Ta!el Reoting of &nto8a #ign# an #to# Cil $ae =ollo8 & !i#it# @aning Sign# 1. DIET DURIN* PRE*N'NC+ 11
N&titional inta7e i# an iotant fa$to in te aintenan$e of atenal ealt &ingegnan$ an in te o!i#ion of ae&ate n&tient# fo e"oni$fetal e!eloent.'##e##ing n&titional #tat&# an o!iing n&titional infoation o efeal to aietitian ae at of te n&#e# e#on#i"ilitie# in enatal $ae. Dieta e9tee# ae a##o$iate 8it i#7# in egnan$. O"e#it i# a##o$iate 8itge#tational ia"ete# eten#ion an onitoing iffi$<ie#. %aln&tition i# a##o$iate8it atenal aneia an fetal go8t e#ti$tion 8ile efi$ien$ of $etain !itain#ei#o#e to $ongenital a"noalitie# foli$ a$i efi$ien$ i# lin7e to te i#7 ofne&al t&"e efe$t# ANTD#. ' "alan$e iet i$ in fe# f&it an !egeta"le i#e$oene. It i# &ent to a!oi &na#te&i;e il7 an $ee#e# an JtK#. Pegnant8oan #o&l a!oi eating li!e &e to it# ig !itain ' $ontent. Vegan# #o&l a!eIon an !itain #&leentation an etni$ go&# la$7ing #&nligt ae a!i#e toa!e e9ta !itain D. ' "alan$e an ae&ate iet i# of &to#t iotan$e &ing egnan$ an la$tation toeet te in$ea#e nee# of te ote an to e!ent n&titional #te##. If atenal#toe# of ion ae oo a# a aen afte eeate egnan$ie# an if ae&ate ion i#not a!aila"le to te ote &ing egnan$ it i# o##i"le tat te fet&# 8ill la o8nin#&ffi$ient ion #toe#. Re&at!o"s)!' +et/ee" Mater"a& a", 0oeta& Ntr!t!o"
Eneg
Inae&ate foo inta7e an oo n&tient &tili;ation
%atenal %aln&tition
Re&$e "loo !ol&e e9an#ion
Inae&ate in$ea#e in $aia$ o&t&t 12
De$ea#e "loo an n&tient #&l to te foet&#
Re&$e la$ental #i;e
Re&$e n&tient tan#fe
=oetal go8t etaation Te in$ea#e in eneg i# to #&ot te go8t of te foet&# la$enta an atenalti##&e an fo te in$ea#e in "a#al eta"oli$ ate &e to aitional 8o7 of go8ingfoet&# an in$ea#e in atenal "o #i;e. 2. PERSON'( )+*IENE '!i$e egaing e#onal giene i# e&all iotant. Te nee to "ate e!e aan to 8ea $lean $lote# #o&l "e e9laine. '"o&t eigt ia eal# #o&l "ea!i#e. Con#tiation #o&l "e a!oie " eg&la inta7e of geen leaf !egeta"le#f&it# an e9ta fl&i. P&gati!e# #&$ a# $a#to oil to elie!e $on#tiation #o&l "ea!oie. (igt o&#eol 8o7 #o&l "e en$o&age "&t an&al #i$al la"o&&ing egnan$ a a!e#el affe$t te fet&#. o =e# ai an #&n#ine Ti# i# ee in a"&nan$e an o#t 8oen ae in te oen ai fo a lage at of te aan it i# goo fo te "&t a!i$e egaing tei #leeing aangeent# #o&l "egi!en. o Te "o8el# Te "o8el a$tion #o&l o$$& ail an 8ito&t te &#e of la9ati!e#. Din7ing gla## of8a 8ate on getting & ea$ oning an in7ing lent of fl&i# &ing te a $anen$o&age ti#. Plent of o&gage in te iet i# al#o elf&l. Con#tiation #o&l "ea!oie " eg&la inta7e of geen leaf !egeta"le# f&it# an e9ta fl&i#.P&gati!e#li7e $a#to oil #o&l "e a!oie to elie!e $on#tiation. o Cae of Teet
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Te &#&al $ae afte eating #o&l $ontin&e. ' ental $e$7 i# a!i#a"le an an ental $aie# #o&l "e teate. U#e #oft "&# in ti# eio. o Pe#onal Cleanline## an Bating D&ing egnan$ #8eet glan# "e$oe oe a$ti!e #o a!i$e fo "ating at lea#t on$ea a efea"l t8i$e "&t $lean $lote# #o&l "e &#e ail. Te nee to "at e!ea an to 8ea $lean $lote# #o&l "e e9laine. Te ai #o&l al#o "e 7et $leanan ti. 3. REST 'ND S(EEP ' egnant 8oan nee# #&ffi$ient e#t. Se #o&l o le## an ligte 8o7. Se &#ta!e -,1 o&# of #lee e!e nigt. Se nee# to ta7e #ot na &ing te a. '# teegnan$ a!an$e# te ote e&ie# oe fe&ent #ot e#t# &ing te a. Se#o&l a!oi #ten&o&# 8o7 $aing ea! loa# o 8eigt# e.g. "inging 8ate folong i#tan$e a8ing of 8ate fo a 8ell et$. Re#t i# iotant fo te aintenan$e of goo ealt. Se #o&l nee ae&ate e#t anela9ation. Rela9ation of te in o&$e# ela9ation of te &#$le an a ela9elo8e &teine #egent an el!i$ floo a7e# it ea#ie fo te "a" to "e "on. 4. P)+SIC'( @ORL ' 0o" o!ie# #ati#fa$tion #elf,e#tee an $onfien$e along 8it finan$ial ea$e ofin. @oen $an $ontin&e 8o7ing in egnan$ a# long a# te 8i# an a# long a#te an tei "a" eain 8ell. '!oian$e of e9o#&e to a;ao&# $ei$al# So7 en!ionent# e9$e##i!e lifting an e9e$i#e an at lea#t an -, o& e#t at nigti# e$oene. 5. EGERCISE E9e$i#e in egnan$ #o&l "e en$o&ageM to&g 8it a!an$ing ge#tation #i$al$on#taint# a liit #oting a$ti!itie#. E9e$i#e $an io!e $aio!a#$&la f&n$tionlo8e "loo e##&e an io!e #elf, e#tee an $onfien$e. S8iing i# oftenelf&l to&go&t egnan$ e#e$iall 8it a!an$ing ge#tation a# it i# e##entiall anon,8eigt "eaing e9e$i#e. It i# a!i#a"le o8e!e to a!oi eteia eationan e9a&#tion. Con#ie e$ea#ing 8eigt "eaing e9e$i#e# li7e 0ogging &nning an $on$entateon non,8eigt "eaing a$ti!itie# #&$ a# #8iing $$ling o #tet$ing. '!i#e e toa!oi i#7 a$ti!itie# #&$ a# #&fing o&ntain $li"ing an #7i!ing. (iit a$ti!itto #ote inte!al#. E9e$i#e fo 1 to 15 in&te#M e#t fo 2 to 3 in&te# ten e9e$i#efo anote 1 to 15 in&te#. Te e9e$i#e #o&l "e e$ea#e a# te egnan$ oge##e#. 6. CO%=ORT'B(E C(OT)IN* 'ND S)OES 14
It i# a!i#a"le to 8ea loo#e an $ofota"le $otton $lote# not too tigt #&$ a# "lo&#eo $olo.Ba##ie 8i$ #&ot# te "ea#t# #o&l "e a!i#e "&t &#t not "e tootigt #o a# to flatten te nile# "&t lift te "ea#t 8ell. ' #&ot fo te a"oen i##oetie# e&ie e#e$iall in a <iga!ia 8o a# en&lo&# a"oen #o teegnant ote #o&l a!i#e to #&ot e 8ole a"oen 8it a ligt "elt.Pegnant #o&l a!oi ig eele #oe#. Se #o&l 8ea flat #oe# to aintain $enteof "alan$e an to e!ent "a$7a$e to #oe e9tent. /. S%OLIN* It #o&l "e #tongl i#$o&age in egnan$. Te taget #o&l "e $e##ation of#o7ing "&t if not o##i"le ten $&tting o8n to a# fe8 a# o##i"le i# a!i#a"le.So7e# Ae#e$iall to#e #o7ing 2a a!e a #ligtl ige in$ien$e ofi#$aiage a #ligtl ige einatal eat ate A2 in$ea#e in 2a #o7e# an35 in$ea#e if 2a an "a"ie# of #o7e# ae 15 to 3 ga ligte tan "a"ie#of non#o7e#. =&teoe #o7ing i# a##o$iate 8it a tee,fol in$ea#e in i#7 of$left alate. So7ing &ing egnan$ o8e!e oe#nt affe$t long te ental ooto e!eloent. Te e$ani## in!ol!e in$l&e intefeen$e of $a"on ono9ie8it o9gen tan#fe #ifting te o9gen i##o$iation $&!e to te left in "ot atenalan fetal eoglo"in an e&$e inte!illo&# "loo flo8. 'oiate a!i$e an#&ot #o&l "e o!ie fo 8oen 8o 8i# to t #toing #o7ing 8it oti& "enefit# a$ie!e if #o7ing i# #toe io to $on$etion. So7ing #o&l "e $&t o8n to a ini& a# ea! #o7ing " te ote $an e#<in "a"ie# &$ #alle tan a!eage #i;e &e to la$ental in#&ffi$ien$. Te einatalotalit aong#t "a"ie# 8o#e ote# #o7e &ing egnan$ i# "et8een 1 to 4e$ent ige tan in non#o7e#. %ote# 8o ae oeate to ea! in7e#Aal$ool "e$oe egnant a!e geate i#7 of egnan$ lo## an if te o not a"ottei "a"ie# a a!e !aio&# #i$al an ental o"le#. )ea! in7ing a# "eena##o$iate 8it fetal al$ool #noe A='S 8i$ in$l&e# inta&teine go8tetaation an e!eloental ela. '!i$e #o&l al#o "e gi!en a"o&t ental $ae an#e9&al "ea!io &ing egnan$. Se9&al inte$o&#e #o&l "e e#ti$te &ing tela#t tie#te of egnan$. -. '(CO)O( 'n e9e$tant ote #o&l "e a!i#e to a!oi in7ing al$ool a# in7ing al$ool i#in0&io&# to te fet&# an al#o to e o8n ealt. It lea# to lo8 "it 8eigt anetaation. Pegnant 8oen ae a!i#e to liit al$ool $on#&tion an a $on#&tion 2 g. 8ee7 A2 &nit# aea# to "e geneall #afe. )ea! al$ool $on#&tion 15
Ageate tan12 &nit# o 12 g. a i# a##o$iate 8it te e!eloent of fetal al$ool #noe. Te #noe i# $aa$tei;e " go8t etaation ne&ologi$al an #t&$t&al efe$t# Afa$ial $aia$ 0oint#. ' le##e egee of al$ool $on#&tion "&t #till geate tan - &nit#a a al#o "e a##o$iate 8it fetal al$ool #noe a# 8ell a# ote a##o$iate feat&e# #&$ a# in$ea#e i#7 of i#$aiage an e&$e ea $i$&feen$e. . BRE'ST C'RE Te ote #o&l a!i$e to $lean e "ea#t &ing "at. If te nile# ae anatoi$all noal noting i# to "e one "eon oina $leanline##. B&t if nile# ae eta$te $oe$tion #o&l "e one. =o ti# ote i# ta> a"o&t nile $ae. Se #o&l 8a# e "ea#t 8it #oa an 8ate. To to&gen te nile# it #o&l "e a##age " &#ing #oa an 8ate an ten oll te "et8een te foefinge an t&" an a8 te o&t e!e a &ing te la#t t8o ont#. Ti# #o&l "e one tee tie# a a. 'fte a##age te nile# #o&l "e ie an an oil #&"#tan$e alie to a7e te #&le. '!i#e ote to 8ea a 8ell, fitting an #&oti!e "a##iee. 1. DRU*S Te ote #o&l "e a!i#e not to ta7e an ei$ine &nle## it i# e#$i"e " teo$to. '# fa a# o##i"le ei$ine #o&l "e a!oie fo te tee ont# &nle## !ee##ential. Te ote &#t info to te o$to a"o&t egnan$ 8en #ee7ing anteatent fo te o$to o ealt e#onnel. Te &#e of &g# tat ae not a"#ol&tel e##ential #o&l "e i#$o&age. Cetain &g# ta7en " te ote &ing egnan$ a affe$t te fet&# a!e#el an $a&#e fetalalfoation#. Te $la##i$al e9ale i# talioie a otoni$ &g 8i$ $a&#eefoe an# an feet of te "a"ie# "on. Te &g o!e o#t #eio&# 8en ta7en"et8een 4 to - 8ee7# of egnan$. Ote e9ale# ae (SD 8i$ i# 7no8n to $a&#e$oo#oal aage #teto$in 8i$ a $a&#e -t ne!e aage an eafne## inte fet&# ioine, $ontaining eaation# 8i$ a $a&#e $ongenital goite in tefet&#. Coti$o#teoi# a iai fetal go8t #e9 oone# a o&$e !iili# anteta$$line a affe$t te go8t of "one# an enael foation of teet. 'ne#teti$agent# in$l&ing etiine aini#tee &ing la"o& $an a!e ee##ant effot on te"a" an ela te on#et of effe$ti!e e#iation. (ate #till in te &eei& if teote i# "ea#t, feeing tee ae $etain &g# 8i$ ae e9$ete in "ea#t il7. 'geat eal of $a&tion i# e&ie in te &g inta7e " egnant 8oen. 11. R'DI'TION
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E9o#&e to aiation i# a o#iti!e ange to te e!eloing fet&#. Te o#t $oon#o&$e of aiation i# a"oinal G,a &ing egnan$. St&ie# a!e #o8n tatotalit ate# fo le&7eia an ote neola# 8ee #ignifi$antl geate aong$ilen e9o#e to inta&teine G,a. Congenital alfoation# #&$ a# i$o$ealae 7no8n to o$$& &e to aiation. )en$e G,a e9aination in egnan$ #o&l "e$aie o&t onl fo efinite ini$ation#. 12.PROTECTIONS =RO% IN=ECTIONS 'ND I((NESSES Infe$tion# in egnan$ ae e#on#i"le fo #ignifi$ant o"iit an otalit. Teie$t finan$ial $o#t# of i#ea#e $an "e a# #tating an ae &$ oe iffi$< toea#&e. Soe $on#e&en$e# of atenal infe$tion la#t a life tie. E&$ation an $o&n#eling ae iotant a#e$t# of $ae fo te e!ention of atenalinfe$tion#. 'ole#$ent# ote# ae at ig i#7# "e$a&#e of ealie atne#. Te e$entten of e9$anging #e9 fo &g# i# $onti"&ting to a i#e in infe$tion ate# e#e$iallaong oo an inoit 8oen. Te e!ention of i#ea#e an te e&$tion ofatenal an neonatal effe$t# $ontin&e to "e on&ental $allenge#. 'n e9e$tant ote &#t "e in#t&$te to ote$t e#elf fo te i#7 of an infe$tione#e$iall ea#le# *ean ea#le# an #ili# "e$a&#e te#e infe$tion# $an $a&#e#ontaneo&# a"otion alfoation ental etaation# #till,"it einatal eat et$.Te $il a e!elo $ongenital #ili#. If te ote i# fo&n a!ing #ili# #e&#t get e#elf teate " te taine ealt e#onnel e#e$iall fo ealt$enteo#ital. 13.SEGU'( 'CTIVITIES Patient ini"ition to a#7 an fail&e to ae## te i##&e " ealt ofe##ional# a#e#<e in $on#iea"le i#$on$etion#. In geneal 8it an &n$oli$ate egnan$tee ae no $ontaini$ation# to $oit&# o ote fo of #e9&al en0oent in egnan$ in$l&ing $&nniling&# an a#t&"ation. Tee i# no e!ien$e tat te#e a!e aaaging infl&en$e on te fet&# o i#7 in&$ing eat&e la"o&. @it a!an$ingge#tation $etain $oital o#ition# a "e #i$all a878a. Tee a "e e$line in#oe 8oen in #e9&al e#ie an a$ti!it in eal egnan$ to8a te en ofegnan$. Coit&# a "e a!oie 8it eat&e &t&e of e"ane# an 8eetee a!e "een e$&ent ei#oe# of 'P) an in te e#en$e of a la$enta e!iaa0o. Te ote #o&l "e a!i#e to a!oi $oit&# &ing te fi#t tee ont# an te la#tt8o ont#. In te fi#t tee ont# it in$ea#e# te i#7 of a"otion. Te i#7 ofa"otion i# oe in ote# 8o a!e e!io&# i#to of a"otion. In late egnan$ itei#o#e# to infe$tion. 17
14. TR'VE( Te ote #o&l "e in#t&$te to a!oi ta!el &ing te fi#t tee an la#t t8oont# of egnan$ e#e$iall long an teio&# 0o&ne.If ta!eling fo long i#tan$e# eio# of a$ti!it an e#t #o&l "e #$e&le. @ile#itting te 8oan $an a$ti$e ee "eating foot $i$ling an altenating $onta$tingan ela9ating iffeent &#$le go&#. =atig&e #o&l "e a!oie. 15. REPORTIN* O= UNTO@'RDS SI*NS 'ND S+%PTO%S Te e9e$tant 8oan &#t "e in#t&$te to eot to ealt e#onnel te follo8ing#ign# an #to#. F Un&#&al ain "leeing fo !agina. F S8elling in te feet an# o fa$e F )eaa$e i;;ine## "l&e !i#ion at tie#. Te#e #to# ini$ate te on#et ofig "loo e##&e 8i$ i# !e angeo&# an $an o!e fatal if tiel $ae i# notgi!en. F )ig fe!e F Ba"# o!eent# not "eing felt. F 'n ote #ig o #to 8i$ i# $on#iee &n&#&al. 16. C)I(D C'RE Te ote #o&l "e e&$ate on !aio&# a#e$t# of $il $ae. %ote $aft $la##e#$an "e aange if o##i"le to tain te ote egaing $ae &ing egnan$ $il"eaing "ea#t feeing 8eaning an $il n&tition go8t an e!eloent of $il$loting i∋ation $ae &ing ino ailent# fail lanning et$.%ote# attening antenatal $lini$# &#t "e gi!en ote $aft e&$ation tat $on#i#t#of n&tition e&$ation giene an $ileaing $il"it eaation an faillanning infoation. 1/.=O((O@ UP VISITS It i# iotant tat ote &#t "e e&$ate a"o&t te nee fo eg&la !i#it# an oe$ae &ing egnan$. Te &#t "e $on!in$e to a follo8 & !i#it an follo8 tein#t&$tion# egaing iet e#onal giene e#t #i$al 8o7 e9e$i#e #o7ingin7ing an ote$tion fo infe$tion# #e9&al a$ti!itie# an ta!el et$.#o a# tooote ealt of "ot ote an te go8ing fet&#. 1-. @'RNIN* SI*NS Te ote #o&l "e gi!en in#t&$tion# tat #e #o&l eot ieiatel an of tefollo8ing 8aning #ignal# li7e #8elling of te feet $on!&l#ion# eaa$e "l&ing ofte !i#ion "leeing o i#$age e !agina an an ote &n&#&al #to#. .S'ec!f!c Hea&t) Protect!o" 18
Se$ifi$ ote$tion fo egnant 8oen# ealt i# an e##ential a#e$t of enatal $ae.Ti# i# "e$a&#e 5 to 6 of 8oen "elonging to lo8 #o$io,e$onoi$ go&# aeanei$ in te la#t tie#te of egnan$. Te a0o $a&#ati!e fa$to# ae ion an foli$a$i efi$ien$ie#. 'naeia i# 7no8n to "e a##o$iate 8it ig in$ien$e of eat&e"it# o#tat& eoage an &eeal #e#i# an to"oe"oli$ enoenain te ote. 'naeia S&!e# in iffeent at# of Inia ini$ate tat a"o&t 5 to 6 e$ent of 8oen"elonging to lo8 #o$io, e$onoi$ go&# ae anei$ in te la#t tie#te of egnan$.Te a0o etiologi$al fa$to# "eing ion an foli$ a$i efi$ien$ie#. It i# 8ell 7no8ntat anaeia e #e i# a##o$iate 8it ig in$ien$e of eat&e "it# o#tat&aeoage an &eeal #e#i# an to"oe"oli$ enoena in te ote. Ote N&titional Defi$ien$ie# Pote$tion i# e&ie again#t ote n&titional efi$ien$ie# tat a o$$& &ingegnan$ #&$ a# otein !itain an ineal efi$ien$ie#. So Vitain ' an D$a#&le# #o&l "e #&lie fo te egnant ote. To9eia# of Pegnan$ Te e#en$e of al"&in in &ine an in$ea#e in "loo e##&e ini$ate# to9eia# ofegnan$. Tei eal ete$tion an anageent ae ini$ate. Effi$ient antenatal $aeinii;e# te i#7 of to9eia# of egnan$. Dia"ete# Ti# la# an iotant ole fo e#entational ia"ete#. To e!ent eal egnan$lo## an $ongenital anoalie# ei$al $ae #o&l "egin "efoe $on$etion. '$olete a##e##ent of te ia"eti$ #tat&# an a##o$iate $oli$ation# i# one to fino&t if #e i# fit to go to&g egnan$. E!al&ation of toi f&n$tion i# al#o e$oene in te 1 ia"ete# a#otoii# i# fe&entl en$o&ntee in te#e 8oen. To#e on oal ogl$ei$ agent# #o&l "e #8it$e to in#&lin tea efea"l "efoe $on$etion. Tetan&# Pote$tion If te ote 8a# not i∋e ealie t8o o#e# of tetan&# to9oi #o&l "e gi!ente fi#t o#e at 16t to 2t 8ee7 an te #e$on o#e at 2t to 24t 8ee7 of egnan$.=o a 8oan 8o a# "een i∋e ealie one "oo#te o#e 8ill "e #&ffi$ient.@en #&$ a "oo#te o#e i# gi!en it 8ill o!ie ne$e##a $o!e fo #&"#e&entegnan$ie# fo te ne9t fi!e ea#. R&"ella 19
R&"ella infe$tion #&ffee " te ote e#e$iall in eal egnan$ $an a!ee!a#tating $on#e&en$e# fo te fet&#. In an attet to e&$e te in$ien$e of$ongenital &"ella efe$t# !a$$ination a# "een &neta7en. )IV S$eening Pegnant 8oen ae eti$all o"ligate to #ee7 ea#ona"le $ae &ing egnan$ anto a!oi $a&#ing a to te fet&#. %atenit n&#e# #o&l "e a!o$ate# fo te fet&#"&t not at te e9en#e of te egnant 8oan. In$ien$e of einatal tan#i##ion foan )IV o#iti!e ote to e fet&# ange# fo 25 to 35. %eto# of e!entingatenal fetal tan#i##ion a fetal teatent $&entl ae not a!aila"le. Until tee i#$ange in te$nolog tat alte# te iagno#i# o teatent of te fet&# te#ting of teegnant 8oan #o&l "e !ol&nta. )ealt $ae o!ie# a!e an o"ligation to a7e#&e te egnant 8oan i# 8ell infoe a"o&t )IV #to# an te#ting. )IV a a## fo an infe$te ote to e fet&# to&g te la$enta o to e infant&ing eli!e o "ea#t feeing. '"o&t one ti of te $ilen of )IV o#iti!eote# infe$te to&g ti# o&tine. Te i#7 of tan#i##ion i# ige if te ote i#ne8l infe$te o if #e a# alea e!eloe 'IDS. Penatal te#ting fo )IV infe$tion#o&l "e one a# eal in egnan$ a# o##i"le fo egnant 8oen 8o ae at i#7 Aif te o tei atne# a!e <ile #e9&al atne# a!e #e9&all tan#itte i#ea#eo &#e illi$it in0e$ta"le &g#. Uni!e#al $onfiential !ol&nta #$eening of egnant 8oen in ig e!alen$e aea# a allo8 infe$te 8oan to $oo#e teae&ti$a"otion a7e an infoe e$i#ion on "ea#t feeing o e$ei!e aoiate $ae. )eatiti# B S$eening fo eatiti# B ai# to eteine 8ete te atient a# e!e "een e9o#eto te !i&# an 8ete i# i&ne to te !i&# o 8ete #e i# a otential i#7 oftan#itting te infe$tion to te neonate e atne an to ealt $ae ofe##ional#. '$o"ine $o&#e of a$ti!e an a##i!e i∋ation $an ten "e &neta7en in teneonate at i#7 afte "it. Te iotan$e of e!enting eatiti# B infe$tion in teneonate i# tat 8ile in te a< atient te !i&# i# $leae 8itin 6 ont# in e$ent of infe$te ini!i&al# in neonate# e$ent "e$oe $oni$ $aie# 8it tei#7 of o#t infe$ti!e eatiti# $io#i# an eato$ell&la $a$inoa. Sili# S$eening fo #ili# #o&l "e efoe fo te e!ention of $ongenital #ili# inte neonate. Teatent $onfe# "enefit# to ote too " e!enting 20
e!eloent of$aio!a#$&la an ne&ologi$al $oli$ation# of te a!an$e #tage# of te i#ea#e. Siliti$ infe$tion in te 8oan i# tan#i##i"le to te fet&# e#e$iall 8en #e i##&ffeing fo ia o #e$ona #tage# afte te 6t ont of egnan$.Ne&ologi$al aage 8it ental etaation i# one of te o#t #eio&# $oli$ation#. Bloo #o&l "e te#te fo #ili# AVDR( at te fi#t !i#it an late in egnan$. It i# o&tine o$e&e in antenatal $lini$# to te#t "loo fo #ili# at te fi#t !i#it.Sin$e te ote $an #&"#e&entl get infe$te 8it #ili# te ieal o$e&e 8o&l"e to te#t "loo fo #ili# "ot eal an late in egnan$. Congenital #ili# i#ea#il e!enta"le. Ten ail in0e$tion# of o$aine eni$illin A6 &nit# aealo#t al8a# ae&ate. *ean %ea#le# R&"ella infe$tion $onta$te &ing te fi#t 16 8ee7# of egnan$ $an $a&#e a0oefe$t# #&$ a# $ataa$t eafne## an $ongenital eat i#ea#e#. Va$$ination of all8oen of $il "eaing age 8o ae #eonegati!e i# e#ia"le. Befoe !a$$inating it i#e#ia"le tat egnan$ i# &le o&t an effe$ti!e $onta$etion "e aintaine fo eigt8ee7# afte !a$$ination "e$a&#e of o##i"le i#7 to te fet&# fo te !i&# #o&l teote "e$oe egnant. R Stat&# It i# a o&tine o$e&e in antenatal $lini$# to te#t te "loo fo Re#&# te in ealegnan$. If te 8oan i# R, negati!e an te &#"an i# R,o#iti!e #e i# 7et&ne #&!eillan$e fo eteination of R, anti"o le!el# &ing antenatal eio. Te"loo i# f&te e9aine at 2-t 8ee7 an 34t to 36t 8ee7 of ge#tation fo anti"oie#.R anti D i&noglo"&lin #o&l "e gi!en at 2-t 8ee7 of ge#tation #o tat #en#iti;ation &ing te fi#t egnan$ $an "e e!ente. If te "a" i# R o#iti!e te R anti,D i&noglo"&lin i# gi!en again 8itin /2 o&# of eli!e. It #o&l al#o "e gi!en afte a"otion. Po#t at&it #o&l "e a!oie. @ene!e tee i# e!ien$e of eolti$ o$e## in fet&# in &teo te ote #o&l "e #ifte to an e&ie $ente #e$iali;e to eal 8it R o"le#. Te in$ien$e of eolti$ i#ea#e &e to Rfa$to in Inia i# e#tiate to "e ao9iatel one fo e!e 4,5 li!e "it#. Penatal *eneti$ S$eening S$eening fo geneti$ a"noalitie# an fo ie$t e!ien$e of #t&$t&al anoalie# i#efoe in egnan$ in oe to a7e te otion of teae&ti$ a"otion a!aila"le8en #e!ee efe$t# ae ete$te. Ti$al e9ale# ae #$eening fo
21
ti#o,21 an#e!ee ne&al t&"e efe$t#. @oen age 35 ea# an a"o!e an to#e 8o aleaa!e an affli$te $il ae at ig i#7. 2.Pre'ar!"# for Co"f!"ee"t Te eaation fo #afe eli!e i# !e iotant. It #o&l "e one 8ell in a!an$e toa!oi an te of iffi$< o eegen$ 8i$ igt o$$& at te tie of eli!e.Te ealt e#onnel i#$&## 8it te $o&le an a "e ote e"e# of te faila"o&t te altenati!e #&ita"le la$e fo $onfineent 8i$ in$l&e# oe ealt $enteo o#ital. Te e$i#ion 8ill een &on te ealt #tat&# of "ot ote an tefet&# i#7 fa$to# an en!ionental $onition# at oe.)ig i#7 ote &#t "e eli!ee at ia ealt $ente fi#t efeal &nit oo#ital at te i#$etion of o$to. )o8e!e a noal ealt ote a "e eli!eeat oe. B&t #e &#t "e eli!ee " a taine "it attenant feale ealt 8o7e A'N%ealt #&e!i#o A ()V to ote$t te life of "ot ote an te "a" ane!ent te fo an infe$tion e#e$iall tetan&#. It i# iotant to aange tan#otin a!an$e fo tan#otation of ote to o#ital o fi#t efeal &nit &ingeegen$ if an. Te follo8ing eaation #o&l "e one fo eli!e at oe. Preparation of the room or some place for confinement: Te oo o #oe la$e in te oo #o&l "e $lean !entilate an 8ell ligte. It#o&l "e 7et ea "efoean. Peaation of te ati$le# in$l&e: @a#e an #&n,ie #&ffi$ient ol $lote#. • @a#e an #&n,ie "e #eet "lan7et an at. • Sto!ega# "&ne at$ "o9. • (age !e##el 8it li "&$7et an a &g a aat an a ta#la. • ' lanten an a to$ • ' ne8 a;o "lae $lean $otton • ' la#ti$ #eet to "e la$e o!e te atte## to ote$t it fo fl&i • an"loo. @a#e an #&n ie linen# o to8el to 8a te "a". • 'angeent# to "&n o ee "& te la$enta. • Te taine Dai #o&l "e ea 8it e o8n 7it fo eli!e. It #o&l a!e tefollo8ing ati$le#: a Enea $an t8o "o8el# an one 7ine ta to$ a ai of #$i##o#. " Clean ga&;e ie$e# $o ligat&e# &$&# #&$7e an "a" 8eiging #ing "alan$e. $ D&g# an anti#eti$ li7e in0e$tion etegin etlate #iit. 22
)an 8a#ing ati$le#. Te#e e&ient# an ati$le# &#t "e 7et ea " te ote an fail #o tattee i# no o"le at te tie of eli!e. Te in#t&$tion# &#t "e gi!en to anoteegaing te#e. Siilal te taine ai# an ealt 8o7e# #o&l "e ea 8it teieli!e 7it fo $on&$t of eli!e at oe. 3.Psyc)o&o#!ca& 're'arat!o" of t)e ot)er P#$ologi$al eaation of te ote i# iotant &ing egnan$ an eli!e.Te e9e$tant ote e#e$iall te ia Paa ote a# fea an an9iet a"o&t$il "it it# o&t$oe an $oli$ation# et$. It i# !e iotant to i#$&## !aio&#a#e$t# of egnan$ an eli!e. Ti# el# in o!e$oing tei fea# anan9ietie#. S&ffi$ient tie an oot&nit &#t "e gi!en to e9e$tant ote# to a!efee an fan7 tal7 on all a#e$t# of egnan$ an eli!e. Te >ote $aft? $la##e#at te %C) $ente# el a geat eal in eo!ing tei fea# an in gaining $onfien$e. 4.0a!&y P&a""!"# =ail lanning i# elate to e!e a#e of te atenit $$le. E&$ational anoti!ational effot# &#t "e initiate &ing te antenatal eio. If te ote a# at8o o oe $ilen #e #o&l "e oti!ate fo &eeal #teili;ation. Te ote#o&l "e e&$ate an oti!ate fo #all fail no an #a$ing of $ilen. 5.E,cat!o" for Se&f 6 Care )ealt aintenan$e i# an iotant a#e$t of enatal $ae. Patient ati$iation in te$ae en#&e# ot eoting of &nto8a e#on#e# to egnan$. Patient a# #toof e#on#i"ilit of ealt aintenan$e i# ote " &ne#taning of atenalaatation# to te go8t of te &n"on $il an a eaine## to lean. N&#e# in teiole of tea$e o!ie atient# 8it te infoation ne$e##a fo $olian$e 8itealt $ae ea#&e#. Te e9e$tant ote nee# infoation a"o&t an #&"0e$t#. D&ing te initial ealta##e##ent te 8oan a a!e ini$ate a nee to lean #elf,$ae a$ti!itie# #&$ a#e!ention of &ina ta$t infe$tion. S&oti!e atenit "a##iee 8it a# to a"#o" i#$age a "e 8on at nigt8a# 8it 8a 8ate an 7ee #ee atenal #iolog an #e9&al $o&n#eling.Bot atne# nee ea##&an$e an #&ot #&ot #ignifi$ant ote 8o $an ea##&e8oan a"o&t e atta$ti!ene## et$. io!e $o&ni$ation 8it e atne failan ote# efe to #o$ial 8o7e if neee o #&oti!e #e!i$e# A finan$ial a##i#tan$e foo #ta# =i#t Tie#te 23
'ntenatal $ae in te fi#t tie#te #tat# 8it a !i#it to te *P afte a i##e eio an$onfiation of egnan$. It al#o o!ie# an ieal oot&nit fo te 8oan toi#$&## an an9ietie# #e a a!e. 7. Heato&o#!ca& I"%est!#at!o"s Te#e in$l&e eoglo"in e#tiation an a $olete "loo i$t&e if ini$ate. Bloogo& eteination an anti"o #$een i# al#o efoe to ientif e#&# negati!e8oen 8o 8ill nee ola9i# again#t e#&# i#oi∋ation. =&ll "loo $o&nt Ti# i# te o#t $oonl efoe eatologi$al in!e#tigation in egnan$.Pegnan$ i# a##o$iate 8it a #iologi$al il&tional aneia &e to geate in$ea#ein la#a !ol&e tan e $ell a## an teefoe te lo8e liit fo a noal )eoglo"in i#1.5 gl in egnan$ a# oo#e to 11.5gl in te non,egnant feale. %an 8oenente egnan$ 8it a lo8 ion e#e!e an teefoe if aneia i# ete$te inegnan$ it #o&l "e aoiatel in!e#tigate " a##e##ent of feitin total ion"ining $aa$it ATIBC #e& an e $ell folate an B12 le!el# "a#e on te "looi$t&e. Te o#t $oon $a&#e of aneia in egnan$ i# ion efi$ien$ aneia. =BC e#tiation i# efoe 4 8ee7l in te #e$on alf of egnan$ an lo8 eoglo"in on ai##ion in la"o& i# an ini$ation fo #ening a #e$ien to te la" fo go& an #a!e in $a#e of intaat& o o#tat& "leeing. Bloo go&ing an #$eening fo anti"oie# Bloo go&ing at "oo7ing ena"le# te eteination 8oen 8o ae e#&# negati!ean teefoe a "e at i#7 of e#&# i#oi∋ation. Te in$ien$e of e#&# i#ea#ea# aati$all fallen o!e te la#t tit ea# te into&$tion of anti Daini#tation. De#ite #$eening at 2- an 34 8ee7# o afte an otential #en#iti;inge!ent an aini#tation of ola$ti$ anti D at te#e tie# a #all n&"e of RDnegati!e 8oen #till e!elo anti,D anti"oie# "e$a&#e of #all #ilent eoage#eoinantl in te ti tie#te o "e$a&#e of fail&e of tiel aini#tation ofanti D i&noglo"&lin. S$eening fo e $ell anti"oie# #o&l "e eeate in all8oen in eal egnan$ in #&"#e&ent egnan$ie# e!en if e#&# o#iti!e a# teea "e ote $lini$all #ignifi$ant anti"oie# a# a $on#e&en$e of e!io&# egnan$o "loo tan#f&#ion. 'n anti"o #$een i# efoe to ete$t te e#en$e ofanti"oie# tat a &t te "a" at i#7 of eolti$ i#ea#e o e#< in iffi$<ie#8it $o##, at$ing "loo fo te ote if e&ie at an age of egnan$ la"o& oo#tnatall. If anti"oie# ae ete$te te tite i# eteine an #&"#e&ent #ale#ta7en fo f&te e#tiation at aoiate tie inte!al. 24
8.Scree"!"# for Ur!"ary Tract !"fect!o" Uina ta$t infe$tion# a "e a#toati$. @ete #toati$ o not &inata$t infe$tion# e#ent a i#7 to "ot ote an fet&#. Pe!ention of te#e infe$tion# i#e##ential. Te 8oan# &ne#taning an &#e of geneal giene ea#&e# aea##e##e. Befoe e!eloing a lan of $ae te n&#e nee# to eli$it feeling# o iea#$on$ening $<&al etni$ eligio&# o ote fa$to# affe$ting ealt a$ti$e#. Teationale "eing tat #oe $a#e# a#toati$ "a$tei&ia an a lo8e &ina ta$tinfe$tion a lea to $oli$ation# of te a!an$e #tage# of te i#ea#e. Te 8oan a nee to lean tat e!e 8oan #o&l al8a# 8ie fo font to "a$7afte &inating o o!ing e "o8el# an &#e a $lean ie$e of toilet ae fo ea$ 8ie.@iing fo "a$7 to font a $a "a$teia fo te e$tal aea to te &etaloening an in$ea#e i#7 of infe$tion. Soft a"#o"ent toilet ti##&e efea"l 8ite an&n#$ente #o&l "e &#e "e$a&#e a# #$ente o inte toilet ae a $a&#eiitation. @oen nee to $ange ant #iel# o #anita na7in# often. Ba$teia $an<il on #oile na7in#. @oen nee to 8ea &neant# an anto#e 8it a$otton $ot$. Te #o&l a!oi 8eaing tigt fitting #la$7# o 0ean# o ant #iel#fo long eio#. Soe 8oen ont a!e an ae&ate fl&i an foo inta7e. 'fte eli$iting e fooefeen$e# te n&#e #o&l a!i#e te 8oen to in7 2 to 3 &at# A- to 12 gla##e#of li&i a a. 19.M!"or D!sor,er of Pre#"a"cy %o#t egnant 8oen o #&ffe fo ino i#oe# &ing egnan$. %inoi#oe i# a $onition $a&#e " egnan$ 8i$ i# not e#ent in te eegnant#tate. It #o&l "e #ol!e in $oe$t tie to e!ent $oli$ation offeing inoteatent an oe e9lanation fo te e&$tion of te#e o"le# an an9iet. Tee9a$t $a&#e of ino i#oe# ae #till &n7no8n "&t it $o&l "e &e to in$ea#ing le!elof oone e#e$iall oge#teone in te "loo. T)e coo" !"or ,!sor,ers are { %oning Si$7ne## A Na&#ea an Voiting { Inige#tion { Vai$o#e !ein# { Ba$7a$e { =ainting { )eat"&n 25
{ { {
Con#tiation It$ing (eg Ca %oning Si$7ne## A Na&#ea an Voiting Na&#ea an !oiting e#e$iall in te oning #oon afte getting o&t of "e ae&#&all $oon in iiga!ia. It a &e to eotional fa$to# fatig&e an$a"oate eta"oli#. So it i# iotant to e!ent it fo getting 8o#e a#eee#i# ga!ia& a o$$&. Pre$ention Ientif te ati$&la oo& of foo# tat ae o#t &#etting an a!oi te oo& of$etain foo# "e$a&#e 8oen ae !e #en#iti!e to #ell#. Eat $a$7e# o "ea 15 in&te# "efoe getting & fo te "e in te oning. '!i$e to $on#&e #all fe&ent eal Ae!e 2 o&# if o##i"le. '!oiing #i$ an gea# foo an $on#&ing otein #na$7 at nigt '!i$e to ta7e ligt an #na$7# in#tea of ea! eal. '!oi "&#ing afte eating. Lee oo 8ell !entilate fo fe# ai. Inige#tion Inige#tion often o$$&# afte eating too &$ of ea! o gea# foo o in7ing too&$ of al$ool. It i# $aa$tei;e " i#$ofot o a "&ning feeling in te i $e#t o #toa$. Pre$ention '!oi fatt gea# an #i$ foo# Eat #all fe&ent eal# in#tea of te &#&al tee eal#. '!oi al$ool $offee an $igaette#. Eat "oile foo#. Vai$o#e !ein# Vai$o#e !ein# ae enlage #&efi$ial !ein# on te leg#M !&l!a an an&# !ai$o#e !ein#ae i#oe of te #e$on an ti tie#te#. It i# &e to in$ea#e atenal agee9$e##i!e 8eigt gain lage foet&# an <ile egnan$ie# et$. Pre$ention E9e$i#e eg&lal an a!oi tigt $lote#. '!oi #taning fo long tie an #itting 8it feet anging o8n. (ift te leg# & 8it e9ta illo8# 8ile #itting e#ting o #leeing. '!oi $o##ing leg# at te 7nee# "e$a&#e it o!ie# te e##&e on e !ein#. 26
Ba$7a$e Ti# i# $oon o"le &ing egnan$ e#e$iall in te ti tie#te#. Sligt"a$7a$e a "e &e to fa< o#t&e an i# oe $oon in <iga!ia. It a "e&e to fatig&e " lifting ea! o"0e$ti!e# an oo o#t&e# fatig&e. Pre$ention Ta7e ae&ate e#t in oe o#ition an o#t&e. @ea #&oti!e #oe# 8it lo8 eel# a!oi ig eel# #oe#. Do enatal e9e$i#e an o not gain oe 8eigt. '!oi e9$e##i!e t8i#ting "ening #tet$ing an al#o e9$e##i!e #taning
o8al7ing. =ainting A Sn$oe It i# te i#oe $oon in #e$on an ti tie#te. %an egnant 8oeno$$a#ionall fall to faint e#e$iall in 8a an $o8e aea#. It i# &e to aneia#&en $ange# of o#ition #taning fo long eio# in 8a an $o8 aea#. Pre$ention '!oi olonge #taning. Re#t in #ie ling o#ition in left lateal to e!ent #&ine oten#ion. Eat eg&lal ion $ontaining foo an lent of li&i. '!i$e to "e alet fo #afet. )eat"&n )eat"&n i# a "&ning #en#ation in te eia#tinal egion &e to "a$7 flo8 Aeg&gitation of a$i $ontent# into te e#oag&# often a$$oanie " "a te#t inte o&t. Pre$ention '!oi# foo# 7no8n to $a&#e ga#ti$ &#et. '!oi gea# fie foo# $offee al$ool an $igaette#. '!i$e to ta7e #all fe&ent eal "&t eat #lo8l. Ta7e ae&ate e#t in #leeing 8it oe illo8# on oe o#ition. E9lain tat ti# i# elate to egnan$ an te o"le i#aea# afte egnan$. Con#tiation Con#tiation i# a $onition of infe&ent ieg&la an iffi$< in a##ing #tool o tea##ing of a #tool. It i# $oon &ing egnan$. It i# &e to la$7 of #i$ala$ti!it o e9e$i#e e$ea#e fl&i# oal ion #&leent e##&e of enlaging &te&#on inte#tine. 27
Pre$ention En$o&age to aintain "o8el a"it going to toilet at #ae tie e!e a an toilet8en a!ing te &ge. En$o&age to in7ing ae&ate li&i A of lea#t 2l e a '!i$e to eat in eg&la #$e&le. En$o&age eating f&it# !egeta"le# gain# an o&gage in te iet. '!i$e to o eg&la ail e9e$i#e. It$ing It$ing i# an &nlea#ant $&taneo&# #en#ation tat o!o7e# a e#ie to #$at$ te #7in. Ita "e &e to oo e#onal giene eat a# ino #7in i#ea#e. Pre$ention '!i$e to ta7e ail "at. '!i$e to 8ea non, iitating $lote# $otton ant. (eg Ca# (eg Ca# ae ainf&l &#$le #a# in te &#$le#. Te o$$& o#t fe&entl atnigt "&t a o$$& at ote tie#. (eg $a# ae oe $oon in te ti tie#te. Pre$ention '!i$e to ta7e eno&g $al$i& A il7 geen leaf !egeta"le# '!i$e to ta7e 8a "at to io!e te $i$&lation. '!i$e to o e9e$i#e eg&lal. Stengten te leg# oint o &ll toe# &8a to8a# te 7nee# ,. INTRANATAL NURSING
Cil"it i# a noal #iologi$al o$e## "&t $oli$ation# a ai#e. Seti$eiaa e#< fo &n#7ille an #eti$ ani&lation# an tetan&# neonato& fo te &#e of &n#teili;e in#t&ent#. Te nee fo effe$ti!e intanatal $ae i# teefoe ini#en#a"le e!en if te eli!e i# going to "e a noal one. Te ea#i# i# on te$leanline##. It entail# $lean an# an fingenail# a $lean #&fa$e fo eli!e $lean$&tting an $ae of te $o an 7eeing "it $anal $lean " a!oiing af&la$ti$e#. )o#ital# an ealt $ente# #o&l "e e&ie fo eli!e 8it i8ife7it# a eg&la #&l of #teile glo!e# an ae# to8el# $leaning ateial# #oa ananti#eti$ #ol&tion a# 8ell a# e&ient fo #teili;ing in#t&ent# an #&lie#. O"0e$ti!e# of Intanatal Cae 1. To eli!e 8it ini& in0& to te ne8"on an ote.
28
2. To "e eaine## to eal 8it $oli$ation# #&$ a# olonge la"o& aeoage $on!&l#ion# ale#entation# ola#e of te $o et$. 3. To o $ae of te "a" at eli!e li7e e#&#$itation $ae of te $o $ae of teee# et$. 4. To e!ent infe$tion. 5. To ete$t an eal 8it an $oli$ation#.e.g. 'nteat& an o#tat&aeoage olonge la"o& ale#entation ola#e $o et$. 6. To e#&#$itate te "a" an to o!ie ieiate $ae to "a". 1. Do!c!&!ary Care %ote# 8it noal o"#teti$ i#to a "e a!i#e to a!e tei $onfineent in teio8n oe# o!ie te oe $onition# ae #ati#fa$to. In #&$ $a#e# te eli!ea "e $on&$te " )ealt @o7e =eale o taine Dai. Ti# i# 7no8n a#>oi$ilia i8ife #e!i$e.? Ad$antages of t&e domi!iliar( mid-ifer( ser$i!e a Te ote eli!e# in te failia #&o&ning# of e oe an ti# a ten toeo!e te fea a##o$iate 8it eli!e in a o#ital " Te $an$e# fo $o## infe$tion ae geneall fe8e at oe tan in te n&#eo#ital an $ Te ote i# a"le to 7ee an ee &on e $ilen an oe#ti$ affai#M ti# aten to ea#e e ental ten#ion %o#t eli!eie# 8ill a!e to ta7e la$e in te oe 8it te ai of =eale )ealt@o7e# o taine ai#. Doi$ilia o&tea$ i# a a0o $oonent of intanatalealt $ae: Te =eale )ealt @o7e 8o i# a i!ot of oi$ilia $ae #o&l "eae&atel taine to e$ogni;e te Hange #ignal# &ing la"o& an #ee7 ieiateel in tan#feing te ote to te neae#t Pia )ealt Cente o )o#ital. Teange #ignal# ae: Sl&ggi# ain# o no ain# afte &t&e of e"e#. *oo ain# fo an o& afte &t&e of e"e# "&t no oge## Pola#e of te $o o an %e$oni& #taine li&o o a #lo8 ieg&la o e9$e##i!el fa#t fetal eat E9$e##i!e H#o8 o "leeing &ing la"o& Colla#e &ing la"o& ' la$enta not #eaate 8itin alf an o& afte eli!e Po#tat& aeoage o $olla#e -.Co'&!cat!o"s a", o+stetr!ca& eer#e"cy ,r!"# !"tra"a& 'er!o, Prolonged La'our 29
Te olonge la"o& a o$$& &e to fa< in o8e fa< in a##age an fa< in a##enge et$. #o te e!enti!e ea#&e# #o&l "e one "efoe te eli!e. Preventive Measures 'ntenatal an eal intanatal ete$tion of te fa$to# li7el to o&$e olongela"o& an ten to in#tit&te it# aoiate anageent. U#e atoga to e$o fetal atenal an la"o& $onition an aintain iteti$&lo&#l 8i$ el in eal ete$tion Sele$ti!e an 0&i$io&# a&gentation of la"o& $an "e eloe " lo8 &t&e ofte e"ane# follo8e " te o9to$in i. Lee !igilant &ing la"o& an aoiate anageent #o&l otl "ein#tit&te if te fi#t i# elae a# e!ien$e fo te $e!i$oga an tee i#tenen$ of #lo8 e#$ent in te #e$on #tage. A'normal Uterine Contra!tion '"noal &teine $onta$tion a "e &e to o"#t&$te la"o& &e to $onta$te el!i$$ongenital alfoation of fet&# li7e o$eal&# "o8 e#entation negle$tetan#!e#e lie et$. Preventive Measures Peioi$ an $aef&l antenatal !i#it#. Eal ete$tion of fa$to# affe$ting la"o& #&$ a# a##age o a##enge &ingantenatal o eal intanatal eio to la$e an aoiate eto of eli!e. Caef&l an $on#tant o"#e!ation of te at&e of &teine $onta$tion an 7eee$o eti$&lo&#l in atoga 'stru!ted La'our Te o"#t&$te la"o& a "e &e to $onta$te el!i# $ealoel!i$ i#ootion$ongenital alfoation of te fet&# et$. Preventive Measures 1. 'ntenatal Ri#7 a##e##ent in te antenatal $lini$: • Pa#t ei$al an o"#teti$al i#to of o"#t&$te la"o&. '##e##ent of el!i# fo "on an #oft a##age anoalie#. '"oinal e9aination fo engageent. Ulta#onoga i# eloe to a##e## fetal anoalie#. Refe te ote in an aoiate la$e o o#ital 8ee te $oi$e of • #afeeli!e i# $ontelate 2. Intanatal Lee $ontin&o&# !igilan$e " &#ing atoga. • 30
• •
Caef&l a##e##ent of te oge## of la"o&. Tiel inte!ention of a olonge la"o& an ot a$tion nee to "e ta7en 8itote# 8o li7el to e!elo o"#t&$te la"o&.
C. PSTNATAL NURSING Cae of te ote an ne8"on afte eli!e i# 7no8n a# o#tnatal o o#tat&$ae. =ollo8ing eli!e te ote an "a" ae !i#ite ail fo ten a#.D&ing ea$ of te#e !i#it# te i8ife =)@ $e$7# teeat&e &l#e ane#iation# of te ote e9aine# e "ea#t# $e$7# te oge## of noalin!ol&tion of &te&# e9aine# lo$ia fo an a"noalit $e$7# &ine an "o8el# ana!i$e# on eineal toileting. Te ieiate o#tnatal $oli$ation# #&$ a# &eeal#e#i# to"ole"iti# an #e$ona aeoage &#t "e 7et in in. 't te en ofte 6t 8ee7 te 8oan nee# an e9aination " te #i$ian in te ealt $ente to$e$7 & in!ol&tion of te &te&# 8i$ #o&l "e $olete " ten. =&te !i#it##o&l "e one on$e a ont &ing te fi#t #i9 ont# an teeafte on$e in 2 to 3ont# &ntil te en of one ea. In &al aea# 8ee onl liite $ae i# o##i"leeffot# #o&l "e ae " te =)@ to gi!e at lea#t 3 to 6 o#tnatal !i#it#. Te $oon$onition# fo&n &ing te late o#tnatal eio ae #&" in!ol&tion of &te&# ola#eof &te&# an $e!i$iti#. Po#tnatal e9aination offe# an oot&nit to ete$t an$oe$t te#e efe$t#. 'neia if e#ent# nee to "e teate. )ealt e&$ation egaingaffoa"le n&titio&# iet an o#tnatal e9e$i#e# to e#toe te #tet$e a"oinal anel!i$ &#$le# &#t "e o!ie to ena"le te ote a!e a noal o#t, at&eio. Te #$ologi$al a#e$t of o#tnatal $ae nee# to "e ae##e "a#e on anee# a##e##ent. Ne8 ote# a a!e tiiit an fea# &e to ignoan$e anin#e$&it egaing te $ae of te "a". In oe to en&e te eotional #te## of$il"it #e e&ie# te #&ot an $oanion#i of e &#"an a# 8ell a#en$o&ageent an a##i#tan$e of fail. =ea an in#e$&it a "e eliinate "oe enatal in#t&$tion# o#tnatal enfo$ing an #&oti!e $ae. O"0e$ti!e# of o#tnatal $ae 1. To e!ent $oli$ation# of te o#t,atal eio. 2. To e#toe oote an aintain ealt of te ote an "a". 3. To oote "ea#t feeing. 4. To e#ta"li# goo n&titio&# of te "a". 5. To $e$7 te ae&a$ of "ea#t feeing. 31
6. To e!ent infe$tion an ientif an ealt o"lei#oe in te "a". /. To #&ot an #tengten te aent# $onfien$e an tei ole 8itin tei failan $<&al en!ionent. -. To o!ie fail lanning in#t&$tion# an #e!i$e#. . To o!ie "a#i$ ealt e&$ation to ote an fail on !aio&# a#e$t# of ote an $il $ae. 1. Co'&!cat!o"s of t)e 'ost"ata& 'er!o, Cetain $oli$ation# a ai#e &ing te o#tnatal eio 8i$ i# "e e$ogni;eeal an ealt 8it otl. Te#e ae a# follo8#: Puer#eral se#sis Ti# i# infe$tion of te genital ta$t 8itin 3 8ee7# afte eli!e. Ti# i# a$$oanie " i#e in teeat&e an &l#e ate fo&l #elling lo$ia ain an tenene## in lo8ea"oen et$. P&eeal #e#i# $an "e e!ente " attention to a#e#i# "efoe an afteeli!e. Ti# i# ati$&lal iotant in oi$ilia i8ife #e!i$e. Prevention P&eeal #e#i# i# to a geat e9tent e!enta"le. Cetain ea#&e #o&l "e ta7en &ne "efoe &ing an follo8ing la"o&. 'ntenatal Dete$t an eai$ate te #eti$ fo$&# e#e$iall lo$ate in te teet g&# ton#il#ile ea# et$. %aintain an io!e te ealt of #tat&# of te atient e#e$iall to ai#e )" le!ele!ent e$la#ia eal teatent of an a"noalitie#. Vaginal e9aination &ing egnan$ e#e$iall in te la#t ont# #o&l "e 7etin a ini& an #o&l "e $aie o&t 8it #ti$t #&gi$al a#e#i#. Inte$o&#e #o&l "e a!oie &ing te la#t t8o ont# to e!ent into&$tion ofogani## li7e #teto$o$$&#. Te atient #o&l a!oi $onta$t 8it e#on# #&ffeing fo infe$tio&# i#ea#e. Te atient #o&l ta7e $ae of e#onal giene. Intanatal Te n&#e o$to an ote e#onnel enteing into la"o& oo #o&l 8ea a#7go8n an $a to e!ent te infe$tion of e#onnel #ea to la"o& oo. Te eli!e #o&l "e $on&$te ta7ing f&ll #&gi$al a#e#i#. %e"e# #o&l "e 7et e#e!e a# long a# o##i"le.
32
@ell anageent on e!e #te of la"o& 8i$ e!ent# o##i"ilit of
infe$tion. '!oi olonge la"o& an ote fo e9a&#tion. Ta&ati$ !aginal eli!e #o&l efea"le "e a!oie an inta&teineani&lation if e&ie #o&l "e one " aintaining #ti$t #&gi$al a#e#i#. 'fte la$enta eli!e e9loe te !agina to eteine if tee ae an ie$e# ofe"ane# o "loo $lot# etaine in &te&#. Enea #o&l "e gi!en in fi#t #tage of la"o& to e!ent te $ontaination of #toolin 2n #tage of la"o&. D&#t #o&l "e a!oie in te la"o& oo. (a$eation of te genital ta$t #o&l "e eaie otl. E9$e##i!e "loo lo## &ing eli!e #o&l "e ela$e otl " "lootan#f&#ion to io!e te geneal "o e#i#tan$e. Po#tnatal Peio '#eti$ e$a&tion #o&l "e ta7en fo at lea#t one 8ee7 follo8ing eli!e &ntilte oen 8o&n te &te&# an te genital ta$t in0& if an ae eale &. N&#e #o&l ta7e a#eti$ e$a&tion an 8ea a#7 8ile gi!ing eineal $ae. Re#ti$t too &$ !i#ito# in 8a. Steili;e #anita a #o&l "e &#e an $ange fe&entl to e!ent lo$iato e$oo#e an "e$oe offen#i!e on te a. Clean te !&l!al aea 8it anti#eti$ #ol&tion afte ea$ &ination anefe$ation. I#olation a# 8ell a# "aie n&#ing ea#&e fo infe$te atient an infant# i#ieati!e. '!i#e to a!oi #e9&al inte$o&#e fo 4,6 8ee7# afte eli!e. T&rom'o#&le'itis Ti# i# an infe$tion of te !ein# of te leg# fe&entl a##o$iate 8it !ai$o#e !ein#.Te leg a "e$oe tene ale an #8ollen. So te ote #o&l "e en$o&age too te leg e9e$i#e to in$ea#e te &#$le tone. "ee# $ein T&rom'osis It i# te to"o#i# of ee !ein of $alf tig o el!i# $lot foation in te a"#en$e ofinfe$tion. Prevention 33
Te tee iotant fa$to# i. e. ta&a #e#i# an aneia #o&l "e e!ente an to"e teate effe$ti!el afte ete$tion. Deation &ing eli!e #o&l "e otl$oe$te.(eg e9e$i#e an eal a"&lation ae en$o&age e#e$iall follo8ing oeati!eeli!e. Post#artum *emorr&age Po#tat& eoage i# te $onition of e9$e##i!e "leeing fo te genital ta$t atan tie follo8ing te "a"# "it & to 6 8ee7# afte eli!e. It a o$$& at antie tat i# &ing ti #tage of la"o& 8itin 24 o&# o afte 24 o&# of la"o&. PREVENTIVE MEASURES O0 PPH SL.N
1.
2.
3. 4.
5.
A"te"ata& Per!o,
En#&e eg&la antenatal $ae
I"tra"ata& Per!o,
Post"ata& Per!o,
<&i$io&#l aini#te • Contin&e to onito #eati!e analge#i$ !ital #ign# ano9to$in %aintain '!oi a#t eli!e • O"#e!e te lo$ia • • eoglo"in le!el a# of te"a". te ao&nt an One #o&l ta7e at $on#i#ten$. • nea a# noal lea#t 2,3 in&te# to eli!e tet&n7 afte te ea i# "on. Ba" #o&l "e • &#e o&t" te eta$te &te&# annot "e &lle o&t. Ce$7 "loo Pe!ent te la"o& Ce$7 eoglo"in • • • "eingolonge le!el ifneee go&ing an ting Ientif ig i#7 '!oi filing an Pe!ent infe$tion • • • ote# A t8in# 7neaing of te &te&# anio# 'P) o&lling te $o an eli!e in a 8ell "efoe tela$ental e&ie o#ital #eaation Sti$t ali$ation of • O"#e!e te ote • a$ti!eanageent of fo t8o o&# afte •
•
34
6.
/.
ti #tagee.g. Ieiate o9to$in Contol Co Ta$tion Uteine %a##age In all $a#e# of te • in&$e o a&gente la"o& "o9to$in #o&l "e 7et on$ontin&o&# o9to$ininf&#ion fo at lea#t oneo& afte eli!e. E9aine te • la$enta an e"ane# an $o $aef&ll
eli!e an en#&e tat te &te&# i# a an $onta$te eno&g. En$o&age te • otefo "ea#t feeing.
•
En$o&age an a##i#tto et te "laeeioi$all an foa"&lation.
In$ersion of t&e uterus Te &te&# i# #ai to "e in!ete if it &# in#ie o&t atiall o $oletel &ingeli!e of te la$enta. Preventive measures Dont elo an eto to e9el te la$enta 8en te &te&# i# ela9e. '!oi &lling $o #i<aneo&#l 8it f&nal e##&e. 'ttet oe te$ni&e to eli!e te la$enta an of an&al eo!al of la$enta. Pa !igilant o"#e!ation fo #eaation of la$enta. Urinar( tra!t infe!tion and in!ontinen!e of urine It i# one of te $oon $a&#e# of &eeal e9ia te in$ien$e "eing 15 of alleli!eie#. It i# &e to fe&ent $atetei;ation eite &ing la"o& o in eal&eei& to elie!e etention of &ine e$&en$e of e!io&# eliti# oo e#onalgiene an !aginal giene ta&a follo8ing in#t&ental eli!e oo fl&i inta7e.It i# e9teel iotant to loo7 fo te#e $oli$ation# in te o#tnatal eio ane!ent o teat te otl. Postnatal ,lues Pegnan$ an &eei& ae igl #te##f&l eio# in a 8oan# life. Te e#on i#teatene " !aio&# $ange# #&$ a# #iologi$al $ange# an eno$ine $ange#o$$&ing in one# "o a# #e i# in eogani;ation of #$e in a$$oan$e 35
8it tene8 ote ole e#e$iall in te fi#t egnan$. Bo iage $ange# an &n$on#$io&#inta#$i$ $onfli$t# elate to egnan$ $il"it an oteoo "e$oea$ti!ate. It i# no 8one tat 25 to of te egnant 8oen e!elo il#$ologi$al #to# in te &eeal eio. Te $oone#t te i# te ilee##ion an iita"ilit 7no8n a# te o#tnatal "l&e#. Prevention '!i$e to te fail an elati!e# to eal oel 8it te o#tnatal #it&ation of teo#tnatal ote. )el e to fee te "a" an a##i#t e in oe#ti$ &tie#. '!i$e to o!ie #&ffi$ient e#t "alan$e iet an to gi!e lo!e an $ae. -.Restorat!o" of ot)er to o't! )ea&t) Te #e$on o"0e$ti!e of o#tnatal $ae i# to o!ie $ae 8ee" te 8oan $ane$&eate #i$all an eotionall fo e e9eien$e of eli!e. Te "oa aea#of ti# $ae fall into tee i!i#ion#: a P#i$al Po#tnatal E9aination# Soon afte eli!e te ealt $e$7#,&# &#t "e fe&ent i.e. t8i$e a a &ing tefi#t 3 a# an #&"#e&entl on$e a a till te &"ili$al $o o# off. 't ea$ ofte#e e9aination# te ealt e#onnel #o&l $e$7# teeat&e &l#e ane#iation e9aine# te "ea#t# $e$7# oge## of noal in!ol&tion of te &te&#e9aine# lo$ia fo an a"noalit $e$7# &ine an "o8el# an a!i#e# o einealtoilet in$l&ing $ae of te #tit$e# if an. Te ieiate o#tnatal $oli$ation# &eeal #e#i# to"ole"iti# #e$ona aeoage #o&l "e 7et in in. 'tte en of 6 8ee7# an e9aination i# ne$e##a to $e$7 & in!ol&tion of te &tei$ #o&l "e $olete " ten. =&te !i#it# #o&l "e one on$e a ont &ing te 6 ont# an teeafte on$e in 2 o 3 ont# till# te en of one ea. In &al aea# onl liite o#tnatal $ae i# o##i"le. Effot# #o&l "e ae " te=)@# to gi!e at lea#t 3 to 6 o#tnatal !i#it#. Te $oon $onition# fo&n one9aination &ing te late o#tnatal eio ae #&" in!ol&tion of &te&# eto!ete&te&# ola#e of &te&# an $e!i$iti#. Po#tnatal e9aination offe# an oot&nit toete$t an $oe$t te#e efe$t#. 'neia Ro&tine eoglo"in e9aination #o&l "e one &ing o#tnatal !i#it# an 8enaneia i# i#$o!ee it #o&l "e teate. In #oe $a#e# it a "e ne$e##a to$ontin&e teatent fo a ea o oe. 36
N&tition To&g a alno&i#e ote i# a"le to #e$ete a# &$ "ea#t il7 a# 8ell, no&i#eone #e oe# it at te $o#t of e o8n ealt. Te n&titional nee# of te ote &#t"e ae&atel et. Often te fail "&get i# liite te ote #o&l "e #o8n teean# o8 #e $an eat "ette 8it le## one. Po#tnatal E9e$i#e# Po#tnatal e9e$i#e# ae ne$e##a to "ing te #tet$e a"oinal an el!i$ &#$le#"a$7 to noal a# &i$7l a# o##i"le. *a&al e#&tion of noal o&#e ol&tie# a "e eno&g to e#toe one# fig&e. " P#$ologi$al Te ne9t "ig aea of o#tnatal $ae in!ol!e# a $on#ieation of te #$ologi$al fa$to#e$&lia to te e$entl eli!ee 8oan. One of te #$ologi$al o"le# i# fea8i$ i# geneall "one of ignoan$e. Ote o"le# ae tiiit an in#e$&itegaing te "a". If a 8oan i# to en&e $eef&ll te eotional #te##e# of$il"it #e e&ie# te #&ot an $oanion#i of e &#"an. =ea anin#e$&it a "e eliinate " oe enatal in#t&$tion. Te #o $alle o#tat&#$o#i# i# ea# e$iitate " "it an it i# ate &n$oon. $ So$ial It a# "een #ai tat te o#t iotant ting a 8oan $an o i# to a!e a "a". Ti# i#onl at of te t&t. Te eall iotant ting i# to n&t&e an ai#e te $il in a8ole#oe fail ato#ee. Se 8it e &#"an &#t e!elo e o8n eto#. .Breast fee,!"# Po#tnatal $ae offe# an e9$ellent oot&nit to fin o&t o8 te ote i# gettingalong 8it e "a" ati$&lal 8it ega to feeing. =o an $ilen "ea#t il7o!ie# te ain #o&$e of no&i#ent in te fi#t ea of life. In #oe #o$ietie#la$tation $ontin&e# to a7e an iotant $onti"&tion to te $il# n&tition fo 1- tont# o longe. Po#tnatal $ae in$l&e# eling te ote to e#ta"li# #&$$e##f&l "ea#t,feeing. =oan "a"ie# "ea#t il7 o!ie# te ain #o&$e of no&i#ent in te fi#t ea oflife. @en te #tana of en!ionental #anitation i# oo an e&$ation lo8 te$ontent of feeing "ottle i# li7el to "e a# n&titionall oo a# it i# "a$teiologi$allangeo&#. It i# teefoe !e iotant to a!i#e ote# to o!ie e9$l&#i!e "ea#tfeeing in te initial ont#. 2.Res'!ratory D!stress Sy",roe a", Neo"ata& Pro+&es As#&()ia Neonatorum
37
'#9ia neonato& i# efine a# fail&e to initiate an aintain #ontaneo&#e#iation 8itin one in&te# of "it. It a &e to ta&ati$ fo$e# o !a$$&eli!e atenal la$7 of o9gen &e to aneia e, e$la#ia inta &teine o9ia&e to la$ental in#&ffi$ien$ 'P) an eat&e #eaation of la$enta. Prevention 'ntenatal #$eening of ig i#7 atient#. o o Colete fetal onitoing ati$&lal in ig i#7 egnan$ go& to en#&e ealete$tion of fetal i#te## Intaat& fetal onitoing. o Res#irator( "istress s(ndrome Re#iato i#te## #noe alo#t al8a# o$$&# in ete "a"ie#. It a "e &e toeat&el atenal aneia e, e$la#ia ia"ete# 'P) afte 2- 8ee7# ofge#tation inta&teine o9ia et$. Prevention 'ini#tation of e9aeta#one in atient# anti$iating ete eli!e o e#e$iall "efoe 34 8ee7# fo l&ng at&it. '##e##ent of l&ng at&it "efoe eat&e in&$tion of la"o& an in&$tion o ofla"o& an to ela te in&$tion a# &$ a# o##i"le 8ito&t an i#7 to te fet&#. Pe!ent fetal o9ia in ia"eti$ ote#. o o '!oi #o7ing aneia e, e$la#ia 'P) an ote $oli$ation &ingegnan$. o S&$tion ieiatel afte "it to atent te ai8a. 3.Pre%e"t!o" of B!rt) I":r!es Intra!ranial in/ur( and &aemorr&age Te inta$anial in0& an aeoage i# &e to ta&a ai $oe##ion a# in"ee$ eli!e fa$e e#entation in#t&ental eli!e. Prevention Coeen#i!e intanatal an antenatal $ae i# te 7e to #&$$e## in te e&$tion ofinta$anial in0&ie#. Pe!ent o ete$t inta&teine fetal a#9ia in ealie#t " inten#i!e fetal o onitoing. o Ei#ioto an &#e of fo$e# to eli!e te eat&e "a" inii;e teinta$anial i#t&"an$e. o '!oi ta&ati$ !aginal eli!e in efeen$e to $ae#aean #e$tion. 38
Diffi$< fo$e# #o&l "e a!oie. In !a$$& eli!e ta$tion i# ae onl afte oe $eali$ ali$ation. o o '!oi olonge an iffi$< la"o&. Pre%e"t!o" of !":r!es !" t)e "e/ +or" +a+!es Coeen#i!e antenatal an intanatal $ae i# te 7e to #&$$e## in e&$tion of "itta&a an $on#e&entl in te e&$tion of einatal otalit an neonatalo"iit. Antenatal period S$een o&t te i#7 "a"ie#. Elo li"eal &#e of Ce#aean Se$tion an ei#ioto. Conta$te el!i# CPD ale#entation #o&l "e in$l&e an anagea$$oingl. Intranatal period D&ing noal eli!e Contin&o&# fetal onitoing to ete$t fetal i#te## e9ta$t "a" "efoe e "e$oe$ooi#e. Ti# $an e!ent ta&ati$ $ee"al ano9ia. Ei#ioto i# to "e one $aef&ll afte la$ing t8o finge# in "et8een te ea ante #tet$e eine&, to e!ent in0& to te #$al. Te ne$7 #o&lnt "e &n&l #tet$e 8ile eli!eing te #o&le# to inii;ein0&ie# to te "a$ial le9&# o #tenoa#toi S'ec!a& care !" 'reter ,e&!%ery Pe!ent ano9ia '!oi #tong #eation. (i"eal ei#ioto an &#e of fo$e# to inii;e inta$anial $oe##ion. 'ini#te !itain 7 1 g inta&#$&lal to e!ent o inii;e aeoagefo te ta&ati;e aea. =o$e# Deli!e Diffi$< fo$e# ae to "e 8itel in efeen$e to te #afe $ae#aean #e$tion. Ne!e al ta$tion &nle## te ali$ation i# a $oe$t one Vento&#e Deli!e It i# elati!el le## ta&ati$ "&t it #o&l "e a!oie in ete "a"ie#. Vaginal Bee$ Deli!e To e!ent inta$anial in0&ie#: , Te $&$ial eio in "ee$ eli!e i# &ingeli!e of te afte, $oing ea. Ne!e "e in a#te &ing eli!e of te ea 8i$ fin little tie to o&l. Ei#ioto #o&l "e one a# a o&tine to inii;e ea $oe##ion. o
39
Contolle eli!e of te ea " fo$e# i# efea"le.
To 're%e"t s'!"a& !":ry : , '$&te "ening at te ne$7 i# to "e e!ente 8ile fo$e#ae "eing alie to te afte $oing ea o eli!e of te ea. To 're%e"t fractre: , Te li"# ae eli!ee in a anne e#$i"e in "ee$eli!e. 4.Ma:or D!sor,ers of Ne/+or" Ba+y #&t&almia Neonatorum Otalia neonat& i# te inflaation of $on0&n$ti!a &ing fi#t 3 8ee7# of life8i$ i# $aa$tei;e " &&lent i#$age #8elling an ene## of affe$te ee#. Prevention 'n #&#i$io&# !aginal i#$age &ing te antenatal eio #o&l "e teate • an te #ti$t a#eti$ te$ni&e #o&l aintain at "it. Te ne8"on "a"# $lo#e ee# an fa$e 8it #teile 8ate an #8a" at "at • tie# to a!oi infe$tion of te ee Te i8ife an ote #o&l al8a# 8a# e an "efoe to&$ing te • "a"# fa$e. Neonatal Tetanus Neonatal Tetan&# i# a eaf&l infe$tion 8it a ig otalit ate. Prevention F %ote #o&l "e gi!en tetan&# to9oi &ing egnan$. F @ile $&tting te $o in#t&ent fo $o $&tting #o&l "e "oile an $o #o&l "e $&t &ne a#eti$ e$a&tion. F Te oo #o&l "e 7et $lean. F Co $ae #o&l "e one ail. m#&alitis '$&te oaliti# i# an infe$tion of &"ili$al #t&. It i# &#&all il a# e#ent a# a#$ant &&lent i#$age. Prevention F %aintain #ti$t #teile te$ni&e &ing goo $&tting an $o e##ing. Lee te en!ionent $lean a# fa a# o##i"le. F Ientifi$ation of atogen " &"ili$al $<&e an i#olate te "a". S0in Infe!tion 1 #em#&igus neonatorum2 Te &ngieni$ en!ionent# $o## infe$tion o $aie ae te #o&$e of infe$tion. 40
F Te "a" "at #o&l "e gi!en 24 o&# offe eli!e. F Te $aie# o #o&$e# of infe$tion ae to "e #o> fo an aoiate ea#&e to "e ta7en. 5. 0a!&y P&a""!"# E!e attet #o&l "e ae to oti!ate ote# 8en te atten o#tnatal $lini$# o&ing o#tnatal $onta$t# to aot a #&ita"le eto fo #a$ing te ne9t "it o foliiting te fail #i;e a# aoiate. Conta$eti!e# tat 8ill not affe$t la$tation a"e e#$i"e ieiatel follo8ing eli!e afte a #i$al e9aination. 7.Hea&t) E,cat!o" to Mot)er a", 0a!&y )ealt e&$ation &ing te o#tnatal eio #o&l $o!e te follo8ing aea#: )giene, e#onal an en!ionental • Bea#t Cae • Bea#t =eeing of infant. • Cae of te Ne8"on "a" • Cae of te &"ili$al $o • Bating te "a" • N&titio&# iet fo te ote • Po#tnatal E9e$i#e • Re#t #lee an a$ti!it • Pegnan$ #a$ing • )ealt $e$7& fo ote an "a" • Pe!ention of infe$tion in te "a" • Bit egi#tation • )giene, e#onal an en!ionental %atenal an neonate# e#onal giene #o&l "e aintaine to e!ent infe$tion. V&l!al $ae an ail "ating #o&l "e one a# lo$ia ainage o$$&#. Cleanline##el# e to fe# an a$ti!ate# eneg to $ae.Peineal $ae #o&l "e one to o"#e!ete ao&nt $olo& oo& an $on#i#ten$ of te lo$ia to 7ee te #tit$ $lean an el in fa#t ealing to e!ent lo$al an a#$ening infe$tion. Bea#t Cae Bea#t $ae i# !e iotant fo "ot ote an "a" "e$a&#e it e!ent# foinfe$tion #o te ote #o&l a!i#e to $lean e "ea#t "efoe an afte ea$ fee8it $lean 8ate an an 8a#ing too. '!i$e to 8ea $lean "a##iee. 41
Bea#t =eeing of infant
Bea#t il7 a# anti,infe$ti!e oetie# tat ote$t te infant fo infe$tion in teeal ont#. It i# a $olete foo an o!ie# all n&tient# neee to infant in te fi#tfe8 ont#. So en$o&age ote to fee te "ea#t feeing fo e "a". Cae of te Ne8"on "a" Te $ae of te ne8"on "a" i# !e iotant to a7e #&e "a" i# ti!ing an toete$t eal #ign of illne## an a"noalitie# an teat it a$$oingl. Cae of te &"ili$al $o Cleanline## of te &"ili$al $o i# e##ential. Te $o i# to "e in#e$te on$e oe foe!ien$e of #liing of ligat&e. De##ing 8it "lan o8e an $o "ine ae notfa!o&e in la$e# 8ee te "a" i# la$e in a $lean en!ionent. )o8e!e te $o#o&l "e $leane at lea#t t8i$e a a an #o&l "e o"#e!e if tee i# "leeing fote #ite of te $o. 'n al#o a!i$e te ote an fail e"e# not to en$lo#e8itin te "a"# na7in 8ee $ontaination " &ine o fa$e# a o$$&. Bating te "a" Bating te "a" i# al#o !e iotant to 7ee $lean an $ofota"le fo te "a" toaintain "loo $i$&lation to e!ent fo infe$tion to ete$t an a"noalitie# oinfe$tion an teat it a$$oingl. N&titio&# iet fo te ote It i# te o#t e##ential "a#i$ nee# of e!e"o "&t e#e$iall fo la$tating ote.@ito&t n&tition te ote $annot get eneg an e$ea#e te #e$etion of il7 #oote #o&l eat igl n&titio&# foo# an #o&# ig in otein an $a"oatee.g. eat #o& Dal #o& et$. Po#tnatal E9e$i#e Po#tnatal e9e$i#e i# te e9e$i#e one afte eli!e in o#tnatal eio 8i$ i# !eiotant to io!e "loo $i$&lation to el in in!ol&tion of eo&$ti!e ogan# toe!ent to"o#i# an to"ole"iti# to oote 8ell"eing of te o#tnatalote to e#toe te tone of te a"oinal te el!i$ &#$le# fo oe ainage of lo$ia. So a!i$e ote to o o#tnatal e9e$i#e. Re#t #lee an a$ti!it %ote #o&l a!e 1o o&# e#t at nigt an 1,2 o&# at aftenoon till 4,6 a# of eli!e. )ea! 8o7ing ea! lifting #o&l "e a!oie in &eei& "e$a&#e it ei#o#e to &teine ola#e. 42
Pegnan$ #a$ing
%ote an fail e"e# #o&l "e a!i#e a"o&t te iotan$e of egnan$ #a$ing. Tee #o&l "e at lea#t te ga of 2 ea# of egnan$ #a$ing. )ealt $e$7& fo ote an "a" Reg&la ealt $e$7& an follo8 & fo ote an "a" i# !e iotant 8it in &eei& eio. Pe!ention of infe$tion in te "a" %i8i!e# a!e an iotant ole to la in $eating a #afe en!ionent tat e$ea#e# te $an$e of infant a$&iing infe$tion afte "it. En$o&aging an a##i#ting te ote fo "ea#t feeing t&# in$ea#ing infant#i&ne ote$tion. En#&ing $aef&l an fe&ent an 8a#ing " all $aee#M te #ileo$e&e eain# te #ingle o#t iotant eto of e!enting te #ea of infe$tion in infant#. Rooing in te infant# 8it i# e ote#. 'e&atel #a$ing $o#t# 8en infant# ae in te n&#e 8it ote infant#. 'l8a# &#e ini!i&al e&ient fo ea$ infant. '!oiing an iitation o ta&a to te infant# #7in an &$o&# e"ane a#inta$t #7in o!ie# a "aie again#t infe$tion. Contolling e9ta !i#ito. Bit egi#tation
RELATED RESEARCHES 1. Care ,r!"# &a+or a", +!rt) for t)e 're%e"t!o" of !"tra'art;re&ate, "eo"ata& ,eat)s< a systeat!c re%!e/ a", De&')! est!at!o" of orta&!ty effect. (ee 'C1 Co&#en# S Da#tat *( Blen$o8e ) Pattin#on R %oan N= )ofe *< )a8# R' B&tta S (a8n
$oeen#i!e eegen$ o"#teti$ $ae #7ille $ae at "it. Te al#o e!ie8e Taitional Bit 'ttenant ATB' taining. Data 8ee a"#ta$te into #tana ta"le# an &alit a##e##e " aate *R'DE $iteia. =o inte!ention# 8it lo8 &alit e!ien$e "&t #tong *R'DE e$oenation fo ileentation an e9et Deli $on#en#&# o$e## 8a# $on&$te to e#tiate $a&#e,#e$ifi$ otalit effe$t#. RESU(TS: Te ientifie e!ien$e fo te effe$t on einatalneonatal otalit of eegen$ o"#teti$ $ae a$7age#: #t&ie# A- o"#e!ational 1 &a#i, e9eiental an fo #7ille $il"it $ae: 1 #t&ie# A- o"#e!ational 2 &a#i, e9eiental. St&ie# 8ee of lo8 &alit "&t te *R'DE e$oenation fo ileentation i# #tong. O& Deli o$e## in$l&e 21 e9et# ee#enting all @)O egion# an a$ie!e $on#en#&# on te e&$tion of intaat&,elate neonatal eat# " $oeen#i!e eegen$ o"#teti$ $ae A-5 "a#i$ eegen$ o"#teti$ $ae A4 an #7ille "it $ae A25. =o TB' taining te ientifie 2 eta,anal#e# an #t&ie# eoting otalit effe$t# A3 $RCT 1 &a#i,e9eiental 5 o"#e!ational. Tee 8a# #&"#tantial "et8een,#t& eteogeneit an te o!eall &alit of e!ien$e 8a# lo8. Be$a&#e te *R'DE e$oenation fo TB' taining i# $onitional on te $onte9t an egion te effe$t 8a# not e#tiate to&g a Deli o in$l&e in te (iST tool. CONC(USION: E!ien$e &alit i# ate lo8 atl "e$a&#e of $allenge# in &neta7ing RCT# fo o"#teti$ inte!ention# 8i$ ae $on#iee #tana of $ae. 'itional $allenge# fo e!ien$e inteetation in$l&e !aing efinition# of o"#teti$ a$7age# an in$on#i#tent ea#&eent of otalit o&t$oe#. T&# te (iST effe$t e#tiate# fo #7ille "it an eegen$ o"#teti$ $ae 8ee "a#e on e9et oinion. U#ing (iST oelling &ni!e#al $o!eage of $oeen#i!e o"#teti$ $ae $o&l a!et 51 intaat&,elate neonatal eat# ea$ ea. In!e#tent in $il"it $ae a$7age# #o&l "e a ioit an a$$oanie " ileentation e#ea$ an f&te e!al&ation of inte!ention ia$t an $o#t. -. Pe&%!c f&oor e=erc!ses ,r!"# a", after 're#"a"cy< a systeat!c re%!e/ of t)e!r ro&e !" 're%e"t!"# 'e&%!c f&oor ,ysf"ct!o". )a!e %'1. A'stra!t OB
e!ention of el!i$ floo o"le# in$l&ing &ina an anal in$ontinen$e an ola#e. D'T' SOURCES: (iteat&e 8a# e!ie8e fo "a$7go&n infoation. %ED(INE E%B'SE CIN')( an o$eeing# of #$ientifi$ eeting# 8ee #ea$e fo e!ien$e, "a#e ata. ' $oeen#i!e liteat&e #ea$ 8a# efoe to fin all #t&ie# tat in!ol!e te &#e of anteat& ano o#tat& P=E#. =o te %ED(INE A166 to 22 an CIN')( A1- to 22 #ea$e# te follo8ing 7e 8o# 8ee &#e: &ina in$ontinen$e Ae!ention an $ontol ea"ilitation tea fe$al in$ontinen$e e9e$i#e o e9e$i#e tea Legel &#$le $onta$tion &#$le ton&# &#$le e!eloent el!i$ floo egnan$ &eei& &eeal i#oe#. =o te E%B'SE A1- to 22 #ea$ te follo8ing 7e 8o# 8ee &#e: i$t&ition i#oe Ae!ention ea" i#ea#e anageent tea fe$al in$ontinen$e la"o& $oli$ation egnan$ i#oe &eeal i#oe anteat& $ae egnan$ 7ine#iotea e9e$i#e el!i$ floo "lae. ' an&al #ea$ 8a# efoe of a!aila"le a"#ta$t# e#ente at te ann&al #$ientifi$ eeting# of te Intenational Continen$e So$iet A1/ 1 to 22 'ei$an Uogne$ologi$ '##o$iation A1/ to 1- 2 to 22 an Intenational Uogne$ologi$al '##o$iation A1/ 1 to 22. T8el!e #t&ie# e!al&ating te ole of anteat& P=E 8ee fo&n of 8i$ 3 anoi;e $ontolle tial# ARCT# $oaing P=E# fo te e!ention of &ina in$ontinen$e to $ontol# 8ee in$l&e. T8el!e #t&ie# e!al&ating o#tat& P=E# fo e!ention of &ina in$ontinen$e 8ee e!ie8e of 8i$ 4 RCT# 8ee in$l&e. =i!e #t&ie# e!al&ating o#tat& P=E# fo te e!ention of anal in$ontinen$e 8ee e!ie8e of 8i$ 4 RCT# 8ee in$l&e. Pati$iant# in te #t&ie# 8ee iiao&# 8oen. D'T' RESU(TS: 'nteat& P=E# 8en &#e 8it "iofee"a$7 an ta> " taine ealt $ae e#onnel &#ing a $on#e!ati!e oel oe# not e#< in #ignifi$ant #ot, te A3 ont# e$ea#e in o#tat& &ina in$ontinen$e o el!i$ floo #tengt. Po#tat& P=E# 8en efoe 8it a !aginal e!i$e o!iing e#i#tan$e o fee"a$7 aea to e$ea#e o#tat& &ina in$ontinen$e an to in$ea#e #tengt. Reine an oti!ational ##te# to efo QLegelQ e9e$i#e# ae ineffe$ti!e in e!enting o#tat& &ina in$ontinen$e. Po#tat& P=E# o not $on#i#tentl e&$e te in$ien$e of anal in$ontinen$e. CONC(USION:
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Po#tat& P=E# aea to "e effe$ti!e in e$ea#ing o#tat& &ina in$ontinen$e. Data egaing te effe$t of P=E# on e!ention of anal in$ontinen$e ae la$7ing an al#o on it# e!ention of ola#e. . T)e R!s>s of Not Breastfee,!"# for Mot)ers a", I"fa"ts 'li#on St&e"e %D %S$ A'stra!t )ealt o&t$oe# in e!eloe $o&ntie# iffe #&"#tantiall fo ote# an infant# 8o fo&la fee $oae 8it to#e 8o "ea#tfee. =o infant# not "eing "ea#tfe i# a##o$iate 8it an in$ea#e in$ien$e of infe$tio&# o"iit a# 8ell a# ele!ate i#7# of $iloo o"e#it te 1 an te 2 ia"ete# le&7eia an #&en infant eat #noe. =o ote# fail&e to "ea#tfee i# a##o$iate 8it an in$ea#e in$ien$e of eenoa&#al "ea#t $an$e o!aian $an$e etaine ge#tational 8eigt gain te 2 ia"ete# o$aial infa$tion an te eta"oli$ #noe. O"#teti$ian# ae &ni&el o#itione to $o&n#el ote# a"o&t te ealt ia$t of "ea#tfeeing an to en#&e tat ote# an infant# e$ei!e aoiate e!ien$e,"a#e $ae #tating at "it. CONC(USIONS =o&la feeing i# a##o$iate 8it a!e#e ealt o&t$oe# fo "ot ote# an infant# anging fo infe$tio&# o"iit to $oni$ i#ea#e. *i!en te $oelling e!ien$e fo iffeen$e# in ealt o&t$oe# "ea#tfeeing #o&l "e a$7no8lege a# te "iologi$ no fo infant feeing. P#i$ian $o&n#eling offi$e an o#ital a$ti$e# #o&l "e aligne to en#&e tat te "ea#tfeeing ote,infant a a# te "e#t $an$e fo a long #&$$e##f&l "ea#tfeeing e9eien$e. 2. Effects of !"ter%e"t!o"s !" 're#"a"cy o" ater"a& /e!#)t a", o+stetr!c otcoes< eta;a"a&ys!s of ra",o!(e, e%!,e"ce S Tangaatina #enio le$t&e$on#<ant in o"#teti$# an atenal ei$ine1 E Rogo;i#7a etal A'stra!t OB
Te ientifie 44 ele!ant anoi;e $ontolle tial# A/2/- 8oen e!al&ating tee $ategoie# of inte!ention#: iet #i$al a$ti!it an a i9e aoa$. O!eall tee 8a# 1.42 7g e&$tion A5 $onfien$e inte!al .5 to 1.- 7g in ge#tational 8eigt gain 8it an inte!ention $oae 8it $ontol. @it all inte!ention# $o"ine tee 8ee no #ignifi$ant iffeen$e# in "it 8eigt Aean iffeen$e 5 g 1 to g an te in$ien$e of lage fo ge#tational age Aelati!e i#7 .-5 .66 to 1. o #all fo ge#tational age A1. ./- to 1.2- "a"ie# "et8een te go&# to&g " it#elf #i$al a$ti!it 8a# a##o$iate 8it e&$e "it 8eigt Aean iffeen$e 6 g 12 to 1 g. Inte!ention# 8ee a##o$iate 8it a e&$e te i#7 of e,e$la#ia A./4 .6 to .2 an #o&le #to$ia A.3 .22 to ./ 8it no #ignifi$ant effe$t on ote $iti$all iotant o&t$oe#. Dieta inte!ention e#<e in te lage#t e&$tion in atenal ge#tational 8eigt gain A3.-4 7g 2.45 to 5.22 7g 8it io!e egnan$ o&t$oe# $oae 8it ote inte!ention#. Te o!eall e!ien$e ating 8a# lo8 to !e lo8 fo iotant o&t$oe# #&$ a# e, e$la#ia ge#tational ia"ete# ge#tational eten#ion an ete eli!e. CONC(USIONS Dieta an life#tle inte!ention# in egnan$ $an e&$e atenal ge#tational 8eigt gain an io!e o&t$oe# fo "ot ote an "a". 'ong te inte!ention# to#e "a#e on iet ae te o#t effe$ti!e an ae a##o$iate 8it e&$tion# in atenal ge#tational 8eigt gain an io!e o"#teti$ o&t$oe#. 3. Does 're"ata& care !'ro%e +!rt) otcoes? A cr!t!ca& re%!e/ %D Le!in =i#$ella A'stra!t OB
47
Penatal $ae a# not "een eon#tate to io!e "it o&t$oe# $on$l&#i!el. )o8e!e oli$a7e# e$iing on f&ning fo enatal $ae &#t $on#ie te#e fining# in te $onte9t of enatal $ae# o!eall "enefit# an otential $o#t,effe$ti!ene##. Co#t,effe$ti!e e&$tion# in lo8 "it 8eigt eli!eie# a "e "eon te #tati#ti$al o8e# of ete$tion of $& ent #t&ie#.
CONCLUSION Pe!enti!e o"#teti$# i# te $on$et of e!ention o eal ete$tion of ati$&laealt e!iation# to&g o&tine eioi$ e9aination# an #$eening#. Te $on$et ofe!enti!e o"#teti$# $on$en# 8it te $on$et# of te ealt an 8ell,"eing of teote an e "a" &ing te antenatal intanatal an o#tnatal eio. It ai# tooote te 8ell, "eing of ote# an "a"ie# an to #&ot #o&n aenting an#ta"le failie#. N&#ing $ae $entee on ealt ootion an ealt aintenan$e&ing egnan$ e#ent# an e9$ellent oot&nit fo n&#e# to tea$ e9e$tantote# a"o&t noal $ange# e9e$te an alet te to a !aiet of i#7 fa$to#.Pe!enti!e O"#teti$ ea#&e $an "e $ategoi;e into tee ain #tage#. Te ae a#follo8#:, F 'ntenatal N&#ing F Intanatal N&#ing F Po#tnatal N&#ing
BIBILIO$RAPHY. (o8eil7
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CO%%UNIT+ )E'(T) NURSIN* APRINCIP(ES 'ND PR'CTICES? 1 #t Eition %atenal an Cil )ealt L&a P&"li#ing )o&#e age no.: 354 366. L.Pa7 A2/ >P'RLS TEGTBOOL O= PREVENTIVE 'ND SOCI'( %EDICINE?M 21 #teitionM Banot &"li$ationMPP: 415 422. S&#an S$ott Ri$$i A213M >ESSENTI'(S O= %'TERNIT+ NE@BORN 'ND @O%ENS )E'(T) NURSIN*?M 3 eitionM (iin$ott &"li$ationM PP: 3-,52. tt In&#tial elation#.na&7i&".$o 888.&"e.$o 48
